NPIMap

Individual provider Active NPI

Fady S Nasrallah, MD

  • Trauma Surgery Physician
  • La Jolla, CA
National Provider Identifier
1871753905
Registry record updated May 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
License
A123254 Issued in CA
Practice address
9888 Genesee Ave
LJ 601
La Jolla, CA 92037-1205
Phone
(858) 626-6353
Fax
(858) 626-6354
NPI assigned
Jun 12, 2008
Last updated
May 2, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2013

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 11176 ND
Surgery Physician 208600000X A123254 CA
Surgical Critical Care Physician 2086S0102X 11176 ND
Surgical Critical Care Physician 2086S0102X A123254 CA
Trauma Surgery Physician 2086S0127X 11176 ND
Trauma Surgery Physician 2086S0127X A123254 CA Primary

Addresses

Primary practice location

9888 Genesee Ave
LJ 601
La Jolla, CA 92037-1205

Mailing address

PO Box 85466
San Diego, CA 92186-5466

Other identifiers 2

IdentifierTypeStateIssuer
10408MedicaidND
1871753905MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130401000186 CA Practitioner - General SurgeryPractitioner - Other (Physician)Practitioner - Critical Care (Intensivists) 4789736505 Reassigns benefits to 1 organization
Practice locations: La Jolla, CA

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Critical Care (Intensivists)
Education
Other, 2001
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)

9834 Genesee Ave
Suite 221
La Jolla, CA 92037-1215
Phone (858) 626-4670

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A123254CAMDSurgical Critical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health Current Accepting new patients
Scripps Health Surgical Critical Care Current Accepting new patients
Scripps Health CurrentSince Mar 1, 2016 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health CurrentSince Mar 1, 2016 Accepting new patients
Scripps Clinic Medical Group Past Accepting new patients
Scripps Health Past Accepting new patients
Scripps Health Past Accepting new patients
Dakota Specialty Institute Past Accepting new patients

Locations

9834 Genesee Ave
Ste 221
La Jolla, CA 92037
Phone (858) 429-6290

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

9888 Genesee Ave
#601
La Jolla, CA 92037
Phone (858) 626-6350

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

10790 Rancho Bernardo Rd
#4S205
San Diego, CA 92127
Phone (858) 605-7171

Interoperability endpoints

  • Direct secure messaging: fnasrallah19542@scrippshlth.medalliesdirect.net

Organizations & group practices 9

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

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1213228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367452800000",
    "number": "1871753905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 85466",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921865466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9888 GENESEE AVE",
            "address_2": "LJ 601",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371205",
            "telephone_number": "858-626-6353",
            "fax_number": "858-626-6354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NASRALLAH",
        "first_name": "FADY",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-12",
        "last_updated": "2013-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ND",
            "license": "11176",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A123254",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "ND",
            "license": "11176",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "CA",
            "license": "A123254",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "ND",
            "license": "11176",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "CA",
            "license": "A123254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10408",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871753905",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.