Individual provider Active NPI

Naomi Susanne Waak, PA

  • Physician Assistant
  • Atascadero, CA
National Provider Identifier
1083876072
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
5905 Capistrano Ave
#C
Atascadero, CA 93422-7219
Phone
(805) 461-7144
Fax
(805) 461-7141
NPI assigned
Jun 30, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

5905 Capistrano Ave
#C
Atascadero, CA 93422-7219

Mailing address

7619 Morro Rd
Atascadero, CA 93422-4433
Phone (805) 461-7144

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110628000870 CA Practitioner - Physician Assistant 4981882685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

5905 Capistrano Ave
Suite C
Atascadero, CA 93422-7219

5905 Capistrano Ave C
Atascadero, CA 93422-7219

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
20278CAMDSpeech-Language Pathologist

Interoperability endpoints

  • Direct secure messaging: naomi.waak@1083722832609284.direct.elationemr.com

Organizations & group practices 1

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 3

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": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1083876072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7619 MORRO RD",
            "city": "ATASCADERO",
            "state": "CA",
            "postal_code": "934224433",
            "telephone_number": "805-461-7144",
            "fax_number": "805-461-7141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5905 CAPISTRANO AVE",
            "address_2": "#C",
            "city": "ATASCADERO",
            "state": "CA",
            "postal_code": "934227219",
            "telephone_number": "805-461-7144",
            "fax_number": "805-461-7141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAAK",
        "first_name": "NAOMI",
        "middle_name": "SUSANNE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-30",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atascadero, CA

Sources for this page

Verify at the official NPI Registry.