NPIMap

Organization Active NPI

Center for Cancer and Blood Disorders

Doing business as CCBD

  • Hematology & Oncology Physician
  • Orange, CA
National Provider Identifier
1083132625
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
CENTER FOR CANCER AND BLOOD DISORDERS
Doing business as
CCBD
Cancer and Blood Care Specialists
Practice address
363 S Main St Ste 485
Orange, CA 92868-3833
Phone
(714) 835-4800
Fax
(714) 835-1900
NPI assigned
Sep 5, 2017
Last updated
Jan 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Authorized official

Name
Stavroula Otis, MDNPI 1477677557
Title
Director
Phone
(323) 376-8936

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X A100358 CA
Hematology & Oncology Physician 207RH0003X NU Primary
Surgery Physician 208600000X NU

Addresses

Primary practice location

363 S Main St Ste 485
Orange, CA 92868-3833

Mailing address

363 S Main St Ste 485
Orange, CA 92868-3833

Other practice location 1

1401 N Tustin Ave Ste 220
Santa Ana, CA 92705
Phone (714) 835-4800

Other practice location 2

1000 W La Veta Ave
Orange, CA 92868-4304
Phone (714) 771-8000

Other names 2

  • CCBD Doing business as
  • Cancer and Blood Care Specialists Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171117002091 CA Part B Supplier - Clinic/Group Practice 9537425996 Receives reassigned benefits from 9 practitioners
Practice locations: Orange, CA; Santa Ana, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0577065Cancer and Blood Care Specialists363 S Main St Ste 485, Orange, CA 92868AccreditationAug 9, 2027

National Provider Directory

National Provider Directory

Locations

363 S Main St
#485
Orange, CA 92868
Phone (714) 835-4800

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1504569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1083132625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "363 S MAIN ST STE 485",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 S MAIN ST STE 485",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683833",
            "telephone_number": "714-835-4800",
            "fax_number": "714-835-1900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1401 N Tustin Ave Ste 220",
            "address_purpose": "LOCATION",
            "city": "Santa Ana",
            "state": "CA",
            "postal_code": "92705",
            "country_code": "US",
            "telephone_number": "714-835-4800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 W La Veta Ave",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928684304",
            "country_code": "US",
            "telephone_number": "714-771-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTER FOR CANCER AND BLOOD DISORDERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-05",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "OTIS",
        "authorized_official_first_name": "STAVROULA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "323-376-8936",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CA",
            "license": "A100358",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCBD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cancer and Blood Care Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.