Active NPI
Michael A Famularo, MD, FACC
- Interventional Cardiology Physician
- San Luis Obispo, CA
National Provider Identifier
1174501845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Cardiology Physician
- License
- G29696
- Practice address
- 1941 Johnson Ave
# 101
San Luis Obispo, CA 93401-4154 - Phone
- (805) 782-8844
- Fax
- (805) 782-8859
- NPI assigned
- Jan 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | G29696 | CA | |
| Interventional Cardiology Physician | 207RI0011X | G29696 | CA | Primary |
Addresses
Primary practice location
1941 Johnson Ave
# 101
San Luis Obispo, CA 93401-4154
Mailing address
1941 Johnson Ave
# 101
San Luis Obispo, CA 93401-4154
Phone (805) 782-8844
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110006126 | Other | CA | RAILROAD MEDICARE |
| ZZZ28458Z | Other | CA | BLUES SHIELD |
| GR0068680 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29696 | CA | MD | Clinical Social Worker |
| G29696 | CA | MD | Interventional Cardiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Straub Clinic & Hospital | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
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- NPI 1851443733
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422403200000",
"number": "1174501845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1941 JOHNSON AVE",
"address_2": "# 101",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934014154",
"telephone_number": "805-782-8844",
"fax_number": "805-782-8859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1941 JOHNSON AVE",
"address_2": "# 101",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934014154",
"telephone_number": "805-782-8844",
"fax_number": "805-782-8859"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAMULARO",
"first_name": "MICHAEL",
"middle_name": "A",
"credential": "MD, FACC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-04",
"last_updated": "2015-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "CA",
"license": "G29696",
"primary": false
},
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "CA",
"license": "G29696",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "110006126",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUES SHIELD",
"identifier": "ZZZ28458Z",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0068680",
"state": "CA"
}
],
"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 Jan 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.