NPIMap

Organization Active NPI

Surgical Associates of Monterey Bay Medical Corporation

  • Surgery Physician
  • Santa Cruz, CA
National Provider Identifier
1003985037
Registry record updated Aug 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SURGICAL ASSOCIATES OF MONTEREY BAY MEDICAL CORPORATION
Practice address
1668 Dominican Way
Santa Cruz, CA 95065-1522
Phone
(831) 464-9962
Fax
(831) 464-9933
NPI assigned
Nov 6, 2006
Last updated
Aug 7, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Shoup
Title
Administrative Assistant
Phone
(831) 464-9962

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary
Vascular Surgery Physician 2086S0129X NU

Addresses

Primary practice location

1668 Dominican Way
Santa Cruz, CA 95065-1522

Mailing address

1668 Dominican Way
Santa Cruz, CA 95065-1522
Phone (831) 464-9962

Other identifiers 1

IdentifierTypeStateIssuer
GR0100250MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040129000614 CA Part B Supplier - Clinic/Group Practice 4688577406 Receives reassigned benefits from 12 practitioners
Practice locations: Santa Cruz, CA

National Provider Directory

National Provider Directory

Locations

2850 Commercial Xing
Ste 101
Santa Cruz, CA 95065
Phone (831) 464-9962

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/4301/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375833600000",
    "number": "1003985037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1668 DOMINICAN WAY",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651522",
            "telephone_number": "831-464-9962",
            "fax_number": "831-464-9933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1668 DOMINICAN WAY",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651522",
            "telephone_number": "831-464-9962",
            "fax_number": "831-464-9933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL ASSOCIATES OF MONTEREY BAY MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2013-08-07",
        "status": "A",
        "authorized_official_last_name": "SHOUP",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "831-464-9962"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0100250",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.