NPIMap

Organization Active NPI

Kesanapalli Pediatrics Professional Medical Corporation

Doing business as Bright Pediatrics

  • Pediatrics Physician
  • San Diego, CA
National Provider Identifier
1780841841
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A56064 Issued in CA
Legal business name
KESANAPALLI PEDIATRICS PROFESSIONAL MEDICAL CORPORATION
Doing business as
Bright Pediatrics
Practice address
7910 Frost Street
Suite 335
San Diego, CA 92123-2771
Phone
(858) 576-8010
Fax
(858) 576-7391
NPI assigned
May 16, 2008
Last updated
Sep 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Deepthi Kesanapalli, M.D.NPI 1487948584
Title
Ceo
Phone
(858) 576-8010

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A56064 CA Primary

Addresses

Primary practice location

7910 Frost Street
Suite 335
San Diego, CA 92123-2771

Mailing address

7910 Frost Street
Suite 335
San Diego, CA 92123-2771
Phone (858) 576-8010

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ01416ZOtherCABLUE SHIELD
A560640MedicaidCA

Other names 2

  • Bright Pediatrics Doing business as
  • Jacobson Pediatrics Former legal business name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0865606Jacobson Pediatrics7910 Frost Street Ste 335, San Diego, CA 92123Certificate of waiverMar 19, 2027

National Provider Directory

National Provider Directory

Locations

7910 Frost St
Ste 335
San Diego, CA 92123
Phone (858) 576-8010

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1780841841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7910 FROST STREET",
            "address_2": "SUITE 335",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232771",
            "telephone_number": "858-576-8010",
            "fax_number": "858-576-7391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7910 FROST STREET",
            "address_2": "SUITE 335",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232771",
            "telephone_number": "858-576-8010",
            "fax_number": "858-576-7391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KESANAPALLI PEDIATRICS PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-16",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "KESANAPALLI",
        "authorized_official_first_name": "DEEPTHI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "858-576-8010",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A56064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ01416Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A560640",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bright Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jacobson Pediatrics",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Jacobson Pediatrics",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.