Individual provider Active NPI

Keith E Kortman, MD

  • Diagnostic Radiology Physician
  • San Diego, CA
National Provider Identifier
1942276332
Registry record updated Oct 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
G48065 Issued in CA
Practice address
8745 Aero Drive
Suite 200
San Diego, CA 92123-1174
Phone
(858) 565-0950
Fax
(858) 244-1100
NPI assigned
Feb 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2007

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

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X G48065 CA
Diagnostic Radiology Physician 2085R0202X G48065 CA Primary
Vascular & Interventional Radiology Physician 2085R0204X G48065 CA
Body Imaging Physician 2085B0100X G48065 CA
Diagnostic Ultrasound Physician 2085U0001X G48065 CA
Nuclear Radiology Physician 2085N0904X G48065 CA
Pediatric Radiology Physician 2085P0229X G48065 CA
Therapeutic Radiology Physician 2085R0203X G48065 CA
Pain Medicine Physician 208VP0000X G48065 CA
Interventional Pain Medicine Physician 208VP0014X G48065 CA

Addresses

Primary practice location

8745 Aero Drive
Suite 200
San Diego, CA 92123-1174

Mailing address

PO Box 23540
San Diego, CA 92193-3540
Phone (858) 565-0950

Other identifiers 9

IdentifierTypeStateIssuer
GR0083817MedicaidCA
GR0083814MedicaidCA
GR0083815MedicaidCA
GR0083816MedicaidCA
ZZZ75341ZMedicaidCA
GR0083810MedicaidCA
GR0083812MedicaidCA
GR0083811MedicaidCA
GR0083813MedicaidCA

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
I20060919000567 CA Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 1052316338 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
University of California, San Diego School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
San Diego Imaging-Chula Vista LLCGroup PAC ID 5496641813, 43 clinicians
San Diego Diagnostic Radiology Medical Group IncGroup PAC ID 0143134353, 47 clinicians

Practice addresses (Care Compare)

765 Medical Ctr CT
Chula Vista, CA 91911-6600
Phone (619) 397-6577

7901 Frost St
San Diego, CA 92123-2701
Phone (858) 939-3600

Hospital & facility affiliations

  • Sharp Memorial Hospital Hospital, San Diego, CA, CCN 050100
  • Sharp Chula Vista Medical Center Hospital, Chula Vista, CA, CCN 050222
  • Sharp Coronado Hospital and Hlthcr Ctr Hospital, Coronado, CA, CCN 050234

Merit-based Incentive Payment System (MIPS)

Final score
98.75 of 100Reported as group
Quality
100
Improvement activities
40
Cost
72.17

Merit-based Incentive Payment System (MIPS)

Final score
90.08 of 100Reported as group
Quality
82.75
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
88.67 of 100Reported as group
Quality
81.04
Promoting interoperability
99
Improvement activities
40
Cost
82.04

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G48065CAMDNeuroradiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
San Diego Diagnostic Radiology Medical Group, Inc. Current Accepting new patients
San Diego Diagnostic Radiology Medical Group Inc Body Imaging Current Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Mar 18, 2024 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Mar 18, 2024 Accepting new patients
San Diego Diagnostic Radiology Medical Group Inc Body Imaging CurrentSince Jan 3, 2025 Accepting new patients
Rady Children'S Hospital San Diego Interventional Pain Medicine Past Accepting new patients
San Diego Diagnostic Radiology Medical Group, Inc. Past Accepting new patients
Sharp Memorial Hospital Interventional Pain Medicine Past Accepting new patients

Locations

765 Medical Center Ct
Chula Vista, CA 91911
Phone (619) 397-6577

751 Medical Center Ct
Chula Vista, CA 91911
Phone (619) 482-3639

8933 Activity Rd
San Diego, CA 92126
Phone (858) 499-2704

8745 Aero Dr
Ste 200
San Diego, CA 92123

7910 Frost St
Ste 100
San Diego, CA 92123
Phone (858) 634-5900

3075 Health Center Dr
San Diego, CA 92123
Phone (858) 637-7888

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

250 Prospect Pl
San Diego, CA 92118
Phone (619) 522-3600

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

3020 Childrens Way
San Diego, CA 92123
Phone (858) 966-5841

Interoperability endpoints

  • Direct secure messaging: kkortman32761@sharphealthcare.direct-ci.com

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 and National Provider Directory roles.

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": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191888000000",
    "number": "1942276332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23540",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921933540",
            "telephone_number": "858-565-0950",
            "fax_number": "858-244-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8745 AERO DRIVE",
            "address_2": "SUITE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231174",
            "telephone_number": "858-565-0950",
            "fax_number": "858-244-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORTMAN",
        "first_name": "KEITH",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2007-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "CA",
            "license": "G48065",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G48065",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "CA",
            "license": "G48065",
            "primary": false
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "CA",
            "license": "G48065",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "CA",
            "license": "G48065",
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "CA",
            "license": "G48065",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "CA",
            "license": "G48065",
            "primary": false
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "CA",
            "license": "G48065",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "CA",
            "license": "G48065",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "CA",
            "license": "G48065",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0083817",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0083814",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0083815",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0083816",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ75341Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0083810",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0083812",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0083811",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0083813",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.