Individual provider Active NPI

Mildred Sturtevant

  • Physician Assistant
  • San Diego, CA
National Provider Identifier
1861081317
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA64258 Issued in CA
Practice address
3811 Valley Centre Dr
San Diego, CA 92130-3318
Phone
(858) 554-7439
NPI assigned
Jan 11, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X PA64258 CA Primary

Addresses

Primary practice location

3811 Valley Centre Dr
San Diego, CA 92130-3318

Mailing address

10790 Rancho Bernardo Rd
San Diego, CA 92127-5705
Phone (858) 554-7439

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241205001140 CA Practitioner - Physician Assistant 3173922937 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scripps HealthGroup PAC ID 9234033853, 1,450 clinicians

Practice addresses (Care Compare)

10862 Calle Verde
La Mesa, CA 91941-7340
Phone (619) 670-5400

2445 Truxtun Rd
Suite 200
San Diego, CA 92106-6154
Phone (858) 554-9100

3811 Valley Centre Dr
San Diego, CA 92130-3318
Phone (858) 764-3000

7565 Mission Valley Rd
San Diego, CA 92108-4431
Phone (619) 245-2350

9888 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 626-4123

9896 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 626-4123

9898 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 455-9100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA64258CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health CurrentSince Dec 16, 2024 Accepting new patients
Scripps Health Multi-Specialty CurrentSince Dec 16, 2024 Accepting new patients
Scripps Health Multi-Specialty Current Accepting new patients
Scripps Clinic Medical Group Past Accepting new patients

Locations

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

File 54433
Los Angeles, CA 90074
Phone (858) 784-5645

3811 Valley Centre Dr
San Diego, CA 92130
Phone (858) 554-8645

10790 Rancho Bernardo Rd
San Diego, CA 92127
Phone (858) 554-2626

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1610323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1861081317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10790 RANCHO BERNARDO RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921275705",
            "telephone_number": "858-554-7439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3811 VALLEY CENTRE DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303318",
            "telephone_number": "858-554-7439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STURTEVANT",
        "first_name": "MILDRED",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-11",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA64258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.