Individual provider Active NPI

Lesley Sudduth, MHS, PA-C

  • Physician Assistant
  • San Diego, CA
National Provider Identifier
1881098937
Registry record updated Oct 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
51871 Issued in CA
Practice address
6280 Jackson Dr Ste 8
San Diego, CA 92119-3436
Phone
(619) 464-1608
NPI assigned
Oct 17, 2014
Last updated
Oct 17, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 51871 CA Primary

Addresses

Primary practice location

6280 Jackson Dr Ste 8
San Diego, CA 92119-3436

Mailing address

6280 Jackson Dr Ste 8
San Diego, CA 92119-3436

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
I20150228000045 CA Practitioner - Physician Assistant 2466778915 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

2025 Soquel Ave
Santa Cruez, CA 95062-1323
Phone (831) 423-4111

550 S Green Valley Rd
Watsonville, CA 95076-3053
Phone (831) 458-5865

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
51871CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Jun 20, 2016 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Cep America-California CurrentSince Feb 1, 2015 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jun 20, 2016 Accepting new patients
County of Santa Clara Past Accepting new patients
Sutter West Bay Medical Foundation Past Accepting new patients
Dignity Health Past Accepting new patients

Locations

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

370 Distel Cir
Los Altos, CA 94022
Phone (650) 254-5200

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 900-3125

2350 W El Camino Real
Fl 2
Mountain View, CA 94040
Phone (650) 691-6174

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

795 El Camino Real
#1112
Palo Alto, CA 94301

123 S San Mateo Dr
San Mateo, CA 94401
Phone (650) 343-4200

2025 Soquel Ave
Santa Cruz, CA 95062
Phone (408) 423-4111

550 S Green Valley Rd
Watsonville, CA 95076
Phone (831) 458-5865

Interoperability endpoints

  • Direct secure messaging: lsudduth342084@hisp.ehr.sutterhealth.org

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413504000000",
    "number": "1881098937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6280 JACKSON DR STE 8",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921193436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6280 JACKSON DR STE 8",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921193436",
            "telephone_number": "619-464-1608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDDUTH",
        "first_name": "LESLEY",
        "credential": "MHS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-17",
        "last_updated": "2014-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "51871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.