NPIMap

Organization Active NPI

Watsonville Emergency Medical Group

  • Emergency Medicine Physician
  • Watsonville, CA
National Provider Identifier
1154571404
Registry record updated Jan 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
WATSONVILLE EMERGENCY MEDICAL GROUP
Practice address
75 Nielson St
Em Department
Watsonville, CA 95076-2468
Phone
(831) 761-5613
Fax
(405) 751-3183
NPI assigned
Sep 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2013

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

Authorized official

Name
Stanley V Hajduk, MD
Title
Cfo
Phone
(831) 763-0535

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

75 Nielson St
Em Department
Watsonville, CA 95076-2468

Mailing address

4401 W Memorial Rd
121
Oklahoma City, OK 73134-1785
Phone (405) 751-4664

Other identifiers 3

IdentifierTypeStateIssuer
ZZZ55932YOtherCABLUE SHIELD
61420880OtherDEPT OF LABOR
1154571404MedicaidCA

National Provider Directory

National Provider Directory

Locations

75 Nielson St
#D
Watsonville, CA 95076
Phone (831) 761-5613

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1222128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359417600000",
    "number": "1154571404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 W MEMORIAL RD",
            "address_2": "121",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341785",
            "telephone_number": "405-751-4664",
            "fax_number": "405-749-4561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 NIELSON ST",
            "address_2": "EM DEPARTMENT",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950762468",
            "telephone_number": "831-761-5613",
            "fax_number": "405-751-3183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATSONVILLE EMERGENCY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-23",
        "last_updated": "2013-01-29",
        "status": "A",
        "authorized_official_last_name": "HAJDUK",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "831-763-0535",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ55932Y",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "61420880",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154571404",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watsonville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2013; 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.