Central Coast Pediatrics Inc

Key facts

NPI: 1083869804
Entity type: Organization (NPI type 2)
Primary specialty: Pediatric Adolescent Medicine Physician 2080A0000X
Legal business name: CENTRAL COAST PEDIATRICS INC
Practice address: 1320 Las Tablas Rd
Suite D
Templeton, CA 93465-9711
Phone: (805) 434-3796
NPI assigned: Nov 20, 2008
Organization subpart: Yes
Parent organization (as reported): CENTRAL COAST PEDIATRICS INC

Authorized official

Name: Dr. Richrd J Macias, MD
Title: Pres/Cfo
Phone: (805) 549-0888

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Central Coast Pediatrics Inc Pediatrics Physician · San Luis Obispo, CA · NPI 1770517724

NPPES parent name

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

Central Coast Pediatrics Inc Pediatrics Physician · San Luis Obispo, CA · NPI 1770517724

NPD tax ID

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Katherine Silva Family Nurse Practitioner · Bakersfield, CA · NPI 1346621547

NPD
Mona Abutouk Pediatrics Physician · San Luis Obispo, CA · NPI 1811556103

NPD (past)
Julie R Anselmo, M.D. Pediatrics Physician · San Luis Obispo, CA · NPI 1669430922

NPD (past) ADOLESCENT MEDICINE
Tamara J Battle, M.D. Pediatric Adolescent Medicine Physician · San Luis Obispo, CA · NPI 1871754986

NPD (past) ADOLESCENT MEDICINE
Richard J Macias, M.D. Pediatric Adolescent Medicine Physician · San Luis Obispo, CA · NPI 1992758742

NPD (past) ADOLESCENT MEDICINE
Michael J McNerney, M.D. Pediatrics Physician · San Luis Obispo, CA · NPI 1982636361

NPD (past)
Kara Danielle November Bryden, M.D. Pediatrics Physician · San Luis Obispo, CA · NPI 1558673632

NPD (past)
Susan Sharon Klaw Trout, MD Pediatrics Physician · San Luis Obispo, CA · NPI 1255891024

NPD (past)

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
05D0913049	Central Coast Pediatrics Inc 1320 Las Tablas Rd, Ste D, Templeton, CA 93465	Certificate of waiver	Aug 15, 2027

National Provider Directory

Tax ID family: Central Coast Pediatrics Inc (2 organizations share this tax ID)
Part of: Central Coast Pediatrics Inc

Locations

1320 Las Tablas Rd
Ste D
Templeton, CA 93465
Phone (805) 434-3796

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pediatric Adolescent Medicine Physician Group: 193400000X SINGLE SPECIALTY GROUP	2080A0000X			Yes

Addresses

Primary practice location

1320 Las Tablas Rd
Suite D
Templeton, CA 93465-9711

Mailing address

1320 Las Tablas Rd
Suite D
Templeton, CA 93465-9711
Phone (805) 434-3796

Other identifiers

Identifier	Type	State	Issuer
GR0059300	Medicaid	CA

Other providers in Templeton, CA

All providers in Templeton, CA · Pediatric Adolescent Medicine Physician in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Care Compare provider data (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.