Individual provider Active NPI

Jithil Luckose Tharayil, MD

  • Pediatrics Physician
  • Los Angeles, CA
National Provider Identifier
1891372868
Registry record updated Jun 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A195503 Issued in CA
Practice address
200 UCLA Medical PLZ Ste 265
Los Angeles, CA 90095-8358
Phone
(310) 825-0867
Fax
(310) 794-5066
NPI assigned
Mar 25, 2021
Last updated
Jun 27, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A195503 CA Primary

Addresses

Primary practice location

200 UCLA Medical PLZ Ste 265
Los Angeles, CA 90095-8358

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240517000899 CA Practitioner - Pediatric Medicine 8022459304 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A195503CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Dec 17, 2024 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Sep 15, 2025 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc Pediatrics CurrentSince Sep 15, 2025 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 17, 2024 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
UCLA Medical Group Pediatrics Past Accepting new patients
Sharp Rees-Stealy Medical Center Past Accepting new patients

Locations

6041 Cadillac Ave
Los Angeles, CA 90034
Phone (323) 857-2000

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

8701 Cuyamaca St
Santee, CA 92071
Phone (619) 568-8025

Interoperability endpoints

  • Direct secure messaging: jtharayil753838@direct.ochin.org

Organizations & group practices 7

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": "1616630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1891372868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 UCLA MEDICAL PLZ STE 265",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958358",
            "telephone_number": "310-825-0867",
            "fax_number": "310-794-5066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THARAYIL",
        "first_name": "JITHIL",
        "middle_name": "LUCKOSE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-25",
        "last_updated": "2025-06-27",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A195503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "6041 Cadillac Ave",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900341702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.