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CHANNING GREDVIG LCSW
NPI 1003113622
Social Worker - Clinical in San Diego, CA

Active since February 16, 2011PECOS EnrolledAccepts Medicare Assignment
3420 KENYON ST, SAN DIEGO, CA 92110(619) 221-6550(619) 221-6556 Get Directions Write a Review

NPPES record last updated: November 29, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Channing Gredvig Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHANNING GREDVIG LCSW (NPI 1003113622) is an individual clinical provider in San Diego, California, licensed in California (64651) and active in the NPI registry since February 2011. He is enrolled in Medicare PECOS and is a graduate of Other (2003).

NPPES Registry Identity

NPI1003113622
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameCHANNING GREDVIGCredential: LCSW
Location Address3420 KENYON STSan Diego, CA 92110-5001
Mailing Address3420 Kenyon StSan Diego, CA 92110-5001 · (619) 221-6550 · Fax (619) 221-6556
Phone(619) 221-6550
Fax(619) 221-6556
Sole ProprietorNo
Medical School CMSOtherGraduated 2003
Enumeration DateFebruary 16, 2011
Last NPPES UpdateNovember 29, 2021
✔ NPI 1003113622 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in CA · 64651
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
3420 KENYON ST, San Diego, CA 92110
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Channing Gredvig Lcsw is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID446566137
PECOS Enrollment IDI20150825005695
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92110 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $62.10 – $184.71
Typical copayment $0.00 (range $15.52 – $46.17)
Most-billed visit code NA
Established Patient
$76.87 typical visit price
range $20.62 – $151.42
Typical copayment $19.21 (range $5.15 – $37.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. ELLEN MICHELE SILVERSTEIN LCSW
Social Worker (Clinical)
3420 KENYON ST
SAN DIEGO, CA 92110
San Diego County (619) 221-6550
MRS. DENISE COSTA RN
Registered Nurse (Psychiatric/Mental Health, Adult)
3420 KENYON ST
SAN DIEGO, CA 92110
San Diego County (619) 221-6101
EBONY CHANTAL VAPOREAN-BUSSEY-PAYNE MFT
Marriage & Family Therapist
3420 KENYON ST
SAN DIEGO, CA 92110
San Diego County (774) 968-0450
MRS. MARY JANE OMENS LCSW
Counselor (Mental Health)
3420 KENYON ST
SAN DIEGO, CA 92110
San Diego County (619) 221-6101
DR. SHAHIDA PARVEEN M.D
Psychiatric Hospital
3420 KENYON ST
SAN DIEGO, CA 92110
San Diego County (877) 496-0450
MELISSA HAWTHORNE-CAMPOS LCSW
Social Worker (Clinical)
3420 KENYON ST
SAN DIEGO, CA 92110
San Diego County (619) 221-6501
ESTHER GLENN MFT
Marriage & Family Therapist
3420 KENYON ST
SAN DIEGO, CA 92110
San Diego County (619) 221-6550
KAISER PERMANENTE
Health Maintenance Organization
3420 KENYON ST
SAN DIEGO, CA 92110
San Diego County (619) 221-6107

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Channing Gredvig's NPI number?

The NPI number for Channing Gredvig is 1003113622. It was assigned to this individual provider in the NPPES registry on February 16, 2011.

Where is Channing Gredvig located?

Channing Gredvig practices at 3420 Kenyon St, San Diego, CA 92110. The listed phone number is (619) 221-6550.

What is Channing Gredvig's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Channing Gredvig enrolled in Medicare?

Yes. Channing Gredvig is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Channing Gredvig was last updated on November 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.