Sebastopol ASC, L.P.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

010000189 Issued in CA

Legal business name

SEBASTOPOL ASC, L.P.

Practice address

6880 Palm Ave
Sebastopol, CA 95472-4270

Phone

(707) 823-7628

Fax

(707) 823-1521

NPI assigned

Mar 29, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Eric J Kahle, M.D.

Title

Corporate Officer

Phone

(707) 823-7628

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Sebastopol ASC LPCCN 55C0001098

Medicare certification status

ActiveFrom the Provider of Services file

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327622400000",
    "number": "1154440972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6880 PALM AVE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724270",
            "telephone_number": "707-823-7628",
            "fax_number": "707-823-1521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6880 PALM AVE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724270",
            "telephone_number": "707-823-7628",
            "fax_number": "707-823-1521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEBASTOPOL ASC, L.P.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2012-01-27",
        "status": "A",
        "authorized_official_last_name": "KAHLE",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CORPORATE OFFICER",
        "authorized_official_telephone_number": "707-823-7628",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "010000189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SUR51098F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "551098",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NPI",
            "identifier": "1154440972",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RET RAILROAD",
            "identifier": "490002015",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZH4909Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Russell Schreiber, MFT
• Maria Eduarda Schuch Goncalves
• Peter A Schulze
• Katherine J Schwimmer
• William Lenard Schwimmer, PHD
• Sebastopol Convalescent Hospital
• Sebastopol Family Pharmacy, Inc.
• Sebastopol Physical Therapy and Pilates Studio
• Sebastopol Union School District
• Sebastopol Urgent Care

• Ambulatory Surgical Clinic/Center in Sebastopol, CA
• Providers in Sebastopol, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (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.