OrganizationActive
Medaid Center
NPI 1508091307 · Internal Medicine Physician · La Jolla, CA
Provider details
- NPI number
- 1508091307
- Entity type
- Organization
- Primary specialty
- Internal Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Mark Henderson, Ceo(858) 405-9653
- License
- C50464 (CA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(85/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
17 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
5580 La Jolla Blvd
Suite 611
La Jolla, CA 92037-7651
Phone: (858) 405-9653
Street-level locationGet directions
Mailing address
5580 La Jolla Blvd
La Jolla, CA 92037-7651
Registry dates
- Enumerated
- 2009-05-22
- Last updated
- 2009-08-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.