NPIMap

Organization Active NPI

California Retina Consultants

  • Retina Specialist (Ophthalmology) Physician
  • San Luis Obispo, CA
National Provider Identifier
1144405309
Registry record updated Jul 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
CALIFORNIA RETINA CONSULTANTS
Practice address
835 Aerovista PL
Suite 110
San Luis Obispo, CA 93401-8740
Phone
(805) 781-0292
Fax
(805) 880-5915
NPI assigned
Jan 7, 2008
Last updated
Jul 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2022

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

Authorized official

Name
Robert Avery, MDNPI 1700985496
Title
Chief Executive Officer
Phone
(805) 963-1648

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207WX0107X Primary

Addresses

Primary practice location

835 Aerovista PL
Suite 110
San Luis Obispo, CA 93401-8740

Mailing address

525 E Micheltorena St
Suite a
Santa Barbara, CA 93103-2254
Phone (805) 963-1648

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040408001116 CA Part B Supplier - Clinic/Group Practice 6608860135 Receives reassigned benefits from 16 practitioners
6 other NPIs on this enrollment
Practice locations: Palmdale, CA; Westlake Village, CA; Valencia, CA; Simi Valley, CA; Santa Maria, CA; San Luis Obispo, CA; Paso Robles, CA; Oxnard, CA…

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
California Retina Consultants10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1199664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1144405309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 E MICHELTORENA ST",
            "address_2": "SUITE A",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "931032254",
            "telephone_number": "805-963-1648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 AEROVISTA PL",
            "address_2": "SUITE 110",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934018740",
            "telephone_number": "805-781-0292",
            "fax_number": "805-880-5915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA RETINA CONSULTANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-07",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "AVERY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "805-963-1648",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.