Blue Wave Anesthesia Group, Inc.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

20A7595 Issued in CA

Legal business name

BLUE WAVE ANESTHESIA GROUP, INC.

Practice address

3350 W Ball Rd
Anaheim, CA 92804-3710

Phone

(714) 827-6700

NPI assigned

Jan 15, 2010

Last updated

Jun 30, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kim S Reis, D.O.

Title

President

Phone

(800) 883-7243

Specialties & licenses 1

Addresses

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 1

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.

• Jacqueline Stark, CRNA

  • Certified Registered Nurse Anesthetist
  • Anaheim, CA
  • NPI 1396742284
  NPD

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

{
    "created_epoch": "1263513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277856000000",
    "number": "1033440987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 N TUSTIN AVE",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927053807",
            "telephone_number": "800-883-7243",
            "fax_number": "714-647-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 W BALL RD",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928043710",
            "telephone_number": "714-827-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WAVE ANESTHESIA GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-15",
        "last_updated": "2010-06-30",
        "status": "A",
        "authorized_official_last_name": "REIS",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "800-883-7243",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "20A7595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nicole Deshawn Blue
• Karen Blueford
• Sumarrah Bluett
• Michael P Blum, D.D.S.

• Anesthesiology Physician in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.