Individual provider Active NPI

Marc D. Wolfsohn, MD

  • Anesthesiology Physician
  • Camarillo, CA
National Provider Identifier
1114954278
Registry record updated Jun 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
G34454 Issued in CA
Practice address
1100 Paseo Camarillo
Camarillo, CA 93010
Phone
(805) 484-8558
Fax
(805) 484-3099
NPI assigned
Jun 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X G34454 CA Primary
Interventional Pain Medicine Physician 208VP0014X G34454 CA

Addresses

Primary practice location

1100 Paseo Camarillo
Camarillo, CA 93010

Mailing address

P.O. Box 5457
San Luis Obispo, CA 93403
Phone (805) 597-8356

Other identifiers 1

IdentifierTypeStateIssuer
00G344540MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081013000487 CA Practitioner - AnesthesiologyPractitioner - Pain Management 6608811807 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G34454CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Spanish Hills Surgery Center, LLC CurrentSince May 11, 2011 Accepting new patients
Spanish Hills Interventional Pain Specialists Inc a Medical Corp Interventional Pain Medicine CurrentSince May 4, 2011 Accepting new patients
Marc D. Wolfsohn MD Inc CurrentSince Jan 1, 2000 Accepting new patients
Alireza Katouzian, MD Inc. Past Accepting new patients

Locations

1100 Paseo Camarillo
Camarillo, CA 93010
Phone (805) 484-8558

11999 San Vicente Blvd
Ste 440
Los Angeles, CA 90049

237 Town Ctr W
Santa Maria, CA 93458

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433203200000",
    "number": "1114954278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 5457",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "93403",
            "telephone_number": "805-597-8356",
            "fax_number": "805-597-8350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 PASEO CAMARILLO",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "93010",
            "telephone_number": "805-484-8558",
            "fax_number": "805-484-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLFSOHN",
        "first_name": "MARC",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2015-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G34454",
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "CA",
            "license": "G34454",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G344540",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Camarillo, CA

Sources for this page

Verify at the official NPI Registry.