NPIMap

Organization Active NPI

Innovative Anesthesia Consultants PC

  • Anesthesiology Physician
  • La Mesa, CA
National Provider Identifier
1154815264
Registry record updated May 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
INNOVATIVE ANESTHESIA CONSULTANTS PC
Practice address
8141 Vista Dr
La Mesa, CA 91941-6429
Phone
(909) 238-6276
NPI assigned
Jun 21, 2018
Last updated
May 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2021

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

Authorized official

Name
Dr. Mark Poblete, MDNPI 1205036423
Title
Owner
Phone
(909) 238-6276

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

8141 Vista Dr
La Mesa, CA 91941-6429

Mailing address

PO Box 34120
Reno, NV 89533-4120

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180904002744 CA Part B Supplier - Clinic/Group Practice 3678823176 Receives reassigned benefits from 44 practitioners
Practice locations: Escondido, CA; San Diego, CA; La Mesa, CA; Chula Vista, CA; Carlsbad, CA

National Provider Directory

National Provider Directory

Locations

5643 Copley Dr
#100
San Diego, CA 92111
Phone (858) 268-3566

8525 Gibbs Dr
Ste 208
San Diego, CA 92123
Phone (909) 238-6276

Practitioners & affiliated clinicians

Practitioners 44

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 44

NPI Registry JSON

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

{
    "created_epoch": "1529539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620691200000",
    "number": "1154815264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34120",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895334120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8141 VISTA DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919416429",
            "telephone_number": "909-238-6276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE ANESTHESIA CONSULTANTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-21",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A",
        "authorized_official_last_name": "POBLETE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-238-6276",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; 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.