Provider Demographics
| NPI: | 1538297726 |
|---|---|
| Name: | SCRIPPS CLINIC MEDICAL GROUP, INC |
| Entity type: | Organization |
| Organization Name: | SCRIPPS CLINIC MEDICAL GROUP, INC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | RICHARD |
| Authorized Official - Middle Name: | H |
| Authorized Official - Last Name: | WALKER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 858-554-7993 |
| Mailing Address - Street 1: | 10790 RANCHO BERNARDO RD |
| Mailing Address - Street 2: | MAIL DROP 4S-205 |
| Mailing Address - City: | SAN DIEGO |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 92127-5705 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 585-554-9100 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 10666 N. TORREY PINES RD. |
| Practice Address - Street 2: | |
| Practice Address - City: | LA JOLLA |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 92037-1027 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 858-554-9100 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-03-01 |
| Last Update Date: | 2023-05-16 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 204F00000X | Allopathic & Osteopathic Physicians | Transplant Surgery | Group - Multi-Specialty | |
| No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 207ZP0105X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | Group - Multi-Specialty |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CA | GR0092940 | Medicaid | |
| CA | GR0092942 | Medicaid | |
| CA | ZZZ74475Z | Medicaid | |
| CA | GR0092941 | Medicaid | |
| CA | GSD001020 | Medicaid | |
| CA | ZZZ81776Z | Medicaid | |
| CA | GR001326C | Medicaid | |
| CA | GAU000440 | Medicaid | |
| CA | GR0013266 | Medicaid | |
| CA | GR001326B | Medicaid | |
| CA | LAB71647F | Medicaid | |
| CA | GR0013263 | Medicaid | |
| CA | GR001326D | Medicaid | |
| CA | GR0097070 | Medicaid | |
| CA | GRE000970 | Medicaid | |
| CA | GR0013260 | Medicaid | |
| CA | GR0013266 | Medicaid | |
| CA | ZZZ74475Z | Medicaid |
