Individual provider Active NPI

Russfir Librado

  • Student in an Organized Health Care Education/Training Program
  • Chesapeake, VA
National Provider Identifier
1992331094
Registry record updated Mar 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1813 Tealwood LN
Chesapeake, VA 23320-0638
Phone
(757) 553-6659
NPI assigned
Mar 20, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1813 Tealwood LN
Chesapeake, VA 23320-0638

Mailing address

1813 Tealwood LN
Chesapeake, VA 23320-0638
Phone (757) 553-6659

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
I20220426002541 CA Practitioner - Physician Assistant 8628465440 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Eastern Virginia Medical School, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Scripps HealthGroup PAC ID 9234033853, 1,450 clinicians

Practice addresses (Care Compare)

10790 Rancho Bernardo Rd
San Diego, CA 92127-5705

10862 Calle Verde
La Mesa, CA 91941-7340
Phone (619) 670-5400

2445 Truxtun Rd
Suite 200
San Diego, CA 92106-6154
Phone (858) 554-9100

3811 Valley Centre Dr
San Diego, CA 92130-3318
Phone (858) 764-3000

7565 Mission Valley Rd
San Diego, CA 92108-4431
Phone (619) 245-2350

9888 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 626-4123

9896 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 626-4123

9898 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 455-9100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
58926CAMDProsthodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health Current Accepting new patients
Scripps Health CurrentSince Aug 29, 2022 Accepting new patients
Scripps Health CurrentSince Aug 29, 2022 Accepting new patients
Scripps Clinic Medical Group Past Accepting new patients

Locations

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

File 54433
Los Angeles, CA 90074
Phone (858) 784-5645

15004 Innovation Dr
San Diego, CA 92128
Phone (858) 487-1800

10790 Rancho Bernardo Rd
San Diego, CA 92127
Phone (858) 554-2626

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.

NPI Registry JSON

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

{
    "created_epoch": "1584662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584662400000",
    "number": "1992331094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1813 TEALWOOD LN",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233200638",
            "telephone_number": "757-553-6659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 TEALWOOD LN",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233200638",
            "telephone_number": "757-553-6659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBRADO",
        "first_name": "RUSSFIR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-20",
        "last_updated": "2020-03-20",
        "certification_date": "2020-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

Verify at the official NPI Registry.