Aescelon Inc.

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Legal business name

AESCELON INC.

Doing business as

Aescelon

Practice address

1389 Jefferson St Unit A507
Oakland, CA 94612-1670

Phone

(415) 689-6406

NPI assigned

Aug 28, 2018

Organization subpart

No

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

Authorized official

Name

Charles Philip Blackshear, MD

Title

President

Phone

(415) 689-6406

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Aescelon Doing business as

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

{
    "created_epoch": "1535414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535414400000",
    "number": "1124509153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1389 JEFFERSON ST UNIT A507",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946121670",
            "telephone_number": "415-689-6406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1389 JEFFERSON ST UNIT A507",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946121670",
            "telephone_number": "415-689-6406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AESCELON INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-28",
        "last_updated": "2018-08-28",
        "status": "A",
        "authorized_official_last_name": "BLACKSHEAR",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "PHILIP",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "415-689-6406",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114362175",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aescelon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Student in an Organized Health Care Education/Training Program in Oakland, CA
• Providers in Oakland, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.