Active NPI
Innovative Anesthesia Consultants PC
- Anesthesiology Physician
- La Mesa, CA
National Provider Identifier
1154815264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- 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
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Mark Poblete, MD
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 DirectoryLocations
5643 Copley Dr
#100
San Diego, CA 92111
Phone (858) 268-3566
Practitioners & affiliated clinicians
Practitioners 44
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Certified Registered Nurse Anesthetist
- San Diego, CA
- NPI 1568980472
CA, Single Specialty
-
- Anesthesiology Physician
- Temecula, CA
- NPI 1467715730
Anesthesiology, CA
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.