Individual provider Active NPI

Peter Stanford Kirk, MD

  • Urology Physician
  • San Luis Obispo, CA
National Provider Identifier
1053817692
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
A195706 Issued in CA
Practice address
225 Prado Rd Ste D
San Luis Obispo, CA 93401-7363
Phone
(805) 786-2500
NPI assigned
Apr 3, 2018
Last updated
Aug 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X A195706 CA Primary

Addresses

Primary practice location

225 Prado Rd Ste D
San Luis Obispo, CA 93401-7363

Mailing address

225 Prado Rd Ste D
San Luis Obispo, CA 93401-7363

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240820003987 CA Practitioner - Urology 9335496975 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Michigan Medical School, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

116 S Palisade Dr
Suite 110
Santa Maria, CA 93454-8905
Phone (805) 349-7133

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.15 of 100Reported as group
Promoting interoperability
99
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection13
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A195706CAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Urology Associates of the Central Coast Urology CurrentSince Sep 1, 2024 Accepting new patients
Urology Associates of the Central Coast Urology CurrentSince Sep 1, 2024 Accepting new patients
Sansum Clinic Past Accepting new patients

Locations

1111 E Ocean Ave
Ste 3
Lompoc, CA 93436
Phone (805) 733-8150

921 Oak Park Blvd
Ste 202
Pismo Beach, CA 93449
Phone (805) 473-7818

116 S Palisade Dr
Ste 110
Santa Maria, CA 93454
Phone (805) 349-7133

225 Prado Rd
Ste D
Sn Luis Obisp, CA 93401
Phone (805) 786-2500

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/9c3d5f6c-4d59-4a7f-9170-c96c3d9e561c/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1053817692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 PRADO RD STE D",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934017363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 PRADO RD STE D",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934017363",
            "telephone_number": "805-786-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRK",
        "first_name": "PETER",
        "middle_name": "STANFORD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-03",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "A195706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.