Channing Gredvig, LCSW in San Diego, CA - Medicare Social Worker Provider

Channing Gredvig, LCSW is a medicare enrolled "Social Worker - Clinical" provider in San Diego, California. His current practice location is 3420 Kenyon St, San Diego, California. You can reach out to his office (for appointments etc.) via phone at (619) 221-6550.

Channing Gredvig is licensed to practice in California (license number 64651) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1003113622.

Contact Information

	Channing Gredvig, LCSW
	3420 Kenyon St, San Diego, CA 92110-5001
	(619) 221-6550
	(619) 221-6556

Map and Direction

Healthcare Provider's Profile

Full Name	Channing Gredvig
Gender	Male
Speciality	Social Worker - Clinical
Location	3420 Kenyon St, San Diego, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1003113622
Provider Enumeration Date: 02/16/2011
Last Update Date: 11/29/2021

Medicare PECOS Information:

PECOS PAC ID: 0446566137
Enrollment ID: I20150825005695

Medical Identifiers

Medical identifiers for Channing Gredvig such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1003113622	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
1041C0700X	Social Worker - Clinical	64651 (California)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Channing Gredvig allows following entities to bill medicare on his behalf.

Entity Name	Southern California Permanente Medical Group
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1770515280 PECOS PAC ID: 6002729175 Enrollment ID: O20031110000678

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Channing Gredvig is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Channing Gredvig, LCSW 3420 Kenyon St, San Diego, CA 92110-5001 Ph: (619) 221-6550	Channing Gredvig, LCSW 3420 Kenyon St, San Diego, CA 92110-5001 Ph: (619) 221-6550

Reviews and Comments

Social Worker in San Diego, CA

Ms. Sonya None Starr, L.C.S.W. Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 4660 Palm Ave, San Diego, CA 92154 Phone: 619-662-5000
Evelina Jaime, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 286 Euclid Ave, Suite 102, San Diego, CA 92114 Phone: 619-266-2111 Fax: 619-266-0496
Miss Crystal Marie Chuk, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 4406 Park Blvd, Suite B, San Diego, CA 92116 Phone: 619-339-3644
Mr. Javier Perez, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 2305 Meade Ave, 3, San Diego, CA 92116 Phone: 619-787-2534
Mr. Jonathan R Boland, LCSW, BCD, MPH Clinical Social Worker Medicare: Medicare Enrolled Practice Location: Naval Consolidated Brig Miramar, 46141 Miramar Way, San Diego, CA 92126 Phone: 619-846-3381
Leah Bogopulsky, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 3020 Childrens Way # 5100, San Diego, CA 92123 Phone: 858-966-1700

Channing Gredvig, LCSW - Medicare Clinical Social Worker in San Diego, CA