Individual provider Active NPI

Rodolfo Castillo-Ruiz, MD

  • Family Medicine Physician
  • San Luis Obispo, CA
National Provider Identifier
1174549182
Registry record updated Apr 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A51574 Issued in CA
Practice address
1551 Bishop St
160
San Luis Obispo, CA 93401-4635
Phone
(805) 269-1500
Fax
(805) 269-1585
NPI assigned
Jul 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A51574 CA Primary

Addresses

Primary practice location

1551 Bishop St
160
San Luis Obispo, CA 93401-4635

Mailing address

2050 S Blosser Rd
Santa Maria, CA 93458-7310
Phone (805) 361-8023

Other identifiers 2

IdentifierTypeStateIssuer
FHC71031FMedicaidCA
HAP71031FOtherCAFAMILY PLANNING

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041028000704 CA Practitioner - Internal Medicine 5395707723 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A51574CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Centers of the Central Coast Inc Current Accepting new patients
Community Health Centers of the Central Coast Inc CurrentSince Jun 1, 2004 Accepting new patients
Community Health Centers of the Central Coast Inc Current Accepting new patients
Department of State Hospitals CurrentSince Aug 12, 2019 Accepting new patients
Community Health Centers of the Central Coast Inc CurrentSince Jun 1, 2004 Accepting new patients
Department of State Hospitals CurrentSince Aug 12, 2019 Accepting new patients
Intercare Medical Group, Inc. Family Medicine Past Accepting new patients

Locations

7512 Morro Rd
Atascadero, CA 93422
Phone (805) 461-3344

150 Tejas Pl
Nipomo, CA 93444
Phone (805) 929-3254

1215 O St
#3
Sacramento, CA 95814
Phone (916) 651-2805

1600 9th St
Ste 150
Sacramento, CA 95814
Phone (916) 651-8811

1551 Bishop St
#160
San Luis Obispo, CA 93401
Phone (805) 269-1500

77 Casa St
#201202
San Luis Obispo, CA 93405
Phone (805) 269-1500

2050 S Blosser Rd
Santa Maria, CA 93458
Phone (805) 361-8014

1551 Bishop St
Ste A160
Sn Luis Obisp, CA 93401
Phone (805) 781-4230

325 Posada Ln
Templeton, CA 93465
Phone (805) 239-0644

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429660800000",
    "number": "1174549182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 S BLOSSER RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934587310",
            "telephone_number": "805-361-8023",
            "fax_number": "805-361-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 BISHOP ST",
            "address_2": "160",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014635",
            "telephone_number": "805-269-1500",
            "fax_number": "805-269-1585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASTILLO-RUIZ",
        "first_name": "RODOLFO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2015-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A51574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC71031F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY PLANNING",
            "identifier": "HAP71031F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.