NPIMap

Individual provider Active NPI

Larry I Emdur, DO, PHD

  • Pulmonary Disease Physician
  • San Diego, CA
National Provider Identifier
1932109642
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
20A4940 Issued in CA
Practice address
6719 Alvarado Rd
#108
San Diego, CA 92120-5270
Phone
(619) 286-8803
Fax
(619) 286-2344
NPI assigned
Jul 22, 2005
Last updated
Jun 6, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 20A4940 CA Primary

Addresses

Primary practice location

6719 Alvarado Rd
#108
San Diego, CA 92120-5270

Mailing address

6699 Alvarado Rd
Ste 2309
San Diego, CA 92120-5241
Phone (619) 698-3004

Other identifiers 3

IdentifierTypeStateIssuer
ZZZ39696ZOtherCABLUE CROSS
00AX4940OtherCAMEDI-CAL
20A4940OtherCALICENSE

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
I20111219000372 CA Practitioner - Critical Care (Intensivists)Practitioner - Pulmonary Disease 9537138607 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)
Education
Michigan State University College of Osteopathic Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6699 Alvarado Rd
Suite 2309
San Diego, CA 92120-5241
Phone (619) 286-8804

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
20A4940CAMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Larry I. Emdur, D.O., PHD. CurrentSince Mar 1, 1989 Accepting new patients
Scripps Health Current Accepting new patients
KND Development 59 LLC Current Accepting new patients
KND Development 59 LLC CurrentSince Aug 12, 2017 Accepting new patients
KND Development 59, LLC CurrentSince Aug 12, 2017 Accepting new patients

Locations

4940 El Cajon Blvd
San Diego, CA 92115
Phone (619) 543-4500

5173 Waring Rd
Ste 125
San Diego, CA 92120

6699 Alvarado Rd
Ste 2309
San Diego, CA 92120
Phone (619) 286-8803

6719 Alvarado Rd
Ste 108
San Diego, CA 92120
Phone (619) 286-8803

Interoperability endpoints

  • Direct secure messaging: lemdur@alvaradoprimary.mdlogic.direct-ci.com
  • Direct secure messaging: lemdur179621@scrippshlth.medalliesdirect.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1121990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1932109642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6699 ALVARADO RD",
            "address_2": "STE 2309",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205241",
            "telephone_number": "619-698-3004",
            "fax_number": "619-698-9480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6719 ALVARADO RD",
            "address_2": "#108",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205270",
            "telephone_number": "619-286-8803",
            "fax_number": "619-286-2344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMDUR",
        "first_name": "LARRY",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "DO, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-22",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "20A4940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "ZZZ39696Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "00AX4940",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "20A4940",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.