Provider Demographics
NPI:1710065933
Name:RADY CHILDREN'S HOSPITAL SAN DIEGO
Entity type:Organization
Organization Name:RADY CHILDREN'S HOSPITAL SAN DIEGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR, REVENUE CYCLE APPLIC
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-966-6779
Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:MAIL CODE 5002
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-1700
Mailing Address - Fax:
Practice Address - Street 1:3020 CHILDRENS WAY # 5002
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-576-1700
Practice Address - Fax:858-966-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QD1600X, 261QH0700X, 261QM0855X, 261QP2000X, 261QR0400X, 405300000X
CA080000028261QE0700X, 282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildrenGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACGP165365Medicaid
CA053303OtherPINNACLE CLAIMS MANAGEMENT
CAZZZH3702ZOtherBLUE SHIELD OF CA
CA053303OtherBLUE CROSS OF CALIFORNIA
CA053303OtherGIC INDEMNITY PLAN
CACGP000355Medicaid
CAZZT40271FMedicaid
CA053303OtherWESTERN GROWERS
CAHSC30271FMedicaid
HI53125301Medicaid
CAZZT30271FMedicaid
HI53125301Medicaid
53303Medicare Oscar/Certification
53303OtherPINNACLE CLAIMS MGMT.
53303OtherGIC INDEMNITY PLAN
53303OtherUNICARE
CAZZT30271FMedicaid