Individual provider Active NPI

Otto J Thomas, MD

  • Anesthesiology Physician
  • Marysville, CA
National Provider Identifier
1073804118
Registry record updated Sep 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A123150 Issued in CA
Practice address
726 4TH St
Marysville, CA 95901-5656
Phone
(530) 749-4300
NPI assigned
Apr 25, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A123150 CA Primary

Addresses

Primary practice location

726 4TH St
Marysville, CA 95901-5656

Mailing address

PO Box 7096
Stockton, CA 95267-0096
Phone (209) 956-7725

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
I20160907000946 CA Practitioner - Anesthesiology 4688960313 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Rochester School of Medicine and Dentistry, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Service Medical GroupGroup PAC ID 1153223219, 236 clinicians

Practice addresses (Care Compare)

3626 Ruffin Rd
San Diego, CA 92123-1810
Phone (619) 565-9666

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A123150CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
First Choice Physician Partners CurrentSince Jun 5, 2019 Accepting new patients
First Choice Physician Partners CurrentSince Jun 5, 2019 Accepting new patients
Cep America - Anesthesia PC Anesthesiology CurrentSince Mar 15, 2021 Accepting new patients
Anesthesia Service Medical Group Anesthesiology CurrentSince Apr 1, 2024 Accepting new patients
Cep America - Anesthesia, PC Anesthesiology Current Accepting new patients
Corona Anesthesia Group, Inc. Anesthesiology CurrentSince Aug 26, 2023 Accepting new patients
Cep America - Anesthesia PC Anesthesiology CurrentSince Mar 15, 2021 Accepting new patients
Cep America - Anesthesia PC Anesthesiology Past Accepting new patients

Locations

800 S Main St
Corona, CA 92882
Phone (909) 625-5411

975 S Fairmont Ave
Lodi, CA 95240
Phone (209) 339-7575

1205 E North St
Manteca, CA 95336
Phone (209) 239-8301

1541 Florida Ave
Ste 101
Modesto, CA 95350
Phone (209) 575-3839

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

1441 Florida Ave
Modesto, CA 95350
Phone (209) 214-7235

1541 Florida Ave
Modesto, CA 95350

2175 Rosaline Ave
Redding, CA 96001
Phone (530) 225-7247

2175 Rosaline Ave
Ste A
Redding, CA 96001
Phone (530) 225-7400

3626 Ruffin Rd
San Diego, CA 92123
Phone (619) 565-9666

Organizations & group practices 8

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 1

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": "1303689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473897600000",
    "number": "1073804118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7096",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952670096",
            "telephone_number": "209-956-7725",
            "fax_number": "209-956-7733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "726 4TH ST",
            "city": "MARYSVILLE",
            "state": "CA",
            "postal_code": "959015656",
            "telephone_number": "530-749-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "OTTO",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-25",
        "last_updated": "2016-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A123150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marysville, CA

Sources for this page

Verify at the official NPI Registry.