NPIMap

Organization Active NPI

Alexander P. Hersel, M.D., Inc

Doing business as Pain Management & Injury Relief Medical Center

  • Pain Medicine (Anesthesiology) Physician
  • Thousand Oaks, CA
National Provider Identifier
1063511475
Registry record updated Apr 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
A79277 Issued in CA
Legal business name
ALEXANDER P. HERSEL, M.D., INC
Doing business as
Pain Management & Injury Relief Medical Center
Practice address
1120 Newbury Rd # 150
Thousand Oaks, CA 91320-3663
Phone
(805) 557-0096
Fax
(805) 557-7360
NPI assigned
Sep 22, 2006
Last updated
Apr 9, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2019

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

Authorized official

Name
Alexander P HerselNPI 1689696718
Title
Owner
Phone
(805) 367-7522

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A79277 CA
Pain Medicine (Anesthesiology) Physician 207LP2900X A79277 CA Primary

Addresses

Primary practice location

1120 Newbury Rd # 150
Thousand Oaks, CA 91320-3663

Mailing address

415 Rolling Oaks Dr
110
Thousand Oaks, CA 91361-1029
Phone (805) 557-0096

Other names 1

  • Pain Management & Injury Relief Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081209000113 CA Part B Supplier - Clinic/Group Practice 3678550795 Receives reassigned benefits from 21 practitioners
Practice locations: Thousand Oaks, CA
O20120625000244 CA DME Supplier - Physician - General Practice 3678550795 Practice locations: Thousand Oaks, CA

National Provider Directory

National Provider Directory

Locations

1304 15th St
Ste 218
Santa Monica, CA 90404
Phone (310) 319-0029

1120 Newbury Rd
Ste 150
Thousand Oaks, CA 91320
Phone (805) 557-0096

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554768000000",
    "number": "1063511475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 ROLLING OAKS DR",
            "address_2": "110",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913611029",
            "telephone_number": "805-557-0096",
            "fax_number": "805-557-7360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 NEWBURY RD # 150",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913203663",
            "telephone_number": "805-557-0096",
            "fax_number": "805-557-7360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEXANDER P. HERSEL, M.D., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2019-04-09",
        "status": "A",
        "authorized_official_last_name": "HERSEL",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-367-7522"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A79277",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "A79277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pain Management & Injury Relief Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thousand Oaks, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; 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.