NPIMap

Individual provider Active NPI

Igor Gavrilyuk, MD

  • Internal Medicine Physician
  • San Diego, CA
National Provider Identifier
1982732277
Registry record updated May 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A94422 Issued in CA
Practice address
4060 Fourth Ave Suite 100
San Diego, CA 92103
Phone
(619) 718-9444
Fax
(619) 718-9440
NPI assigned
Mar 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A94422 CA Primary

Addresses

Primary practice location

4060 Fourth Ave Suite 100
San Diego, CA 92103

Mailing address

4060 Fourth Ave Ste 100
San Diego, CA 92103-2120
Phone (619) 718-9444

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
I20070703000736 CA Practitioner - Internal Medicine 4688774672 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rancho Family Medical Group IncGroup PAC ID 6305741240, 112 clinicians

Practice addresses (Care Compare)

4060 4TH Ave
Suite 100
San Diego, CA 92103-2120
Phone (619) 718-9444

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A94422CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health Current Accepting new patients
Rancho Family Medical Group, Inc. CurrentSince Mar 1, 2023 Accepting new patients
Regents of the University of California Past Accepting new patients
UC San Diego Health - Rancho Family Medical Group Past Accepting new patients
Scripps Health Past Accepting new patients

Locations

263 Church Ave
Chula Vista, CA 91910
Phone (619) 422-1324

4060 4th Ave
San Diego, CA 92103
Phone (619) 298-9931

4060 4th Ave
Ste 100
San Diego, CA 92103
Phone (619) 299-9870

4077 5th Ave
San Diego, CA 92103
Phone (619) 260-7245

28780 Single Oak Dr
Ste 160
Temecula, CA 92590
Phone (951) 658-9461

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: igavrilyuk81033@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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304380800000",
    "number": "1982732277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 FOURTH AVE STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032120",
            "telephone_number": "619-718-9444",
            "fax_number": "619-718-9440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 FOURTH AVE SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92103",
            "telephone_number": "619-718-9444",
            "fax_number": "619-718-9440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAVRILYUK",
        "first_name": "IGOR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-01",
        "last_updated": "2011-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A94422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.