Golden State Otolaryngology Medical

Primary specialty

SpecialistTaxonomy code 174400000X

License

A69121 Issued in CA

Legal business name

GOLDEN STATE OTOLARYNGOLOGY MEDICAL

Practice address

301 Drummond Ave
Ridgecrest, CA 93555-3187

Phone

(760) 371-7329

Fax

(661) 726-6291

NPI assigned

Mar 14, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Ruwanthi S Campano, M.D.NPI 1023018389

Title

President

Phone

(661) 726-6277

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• GSOMC-Billing Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Golden State Otolaryngology3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Golden State Otolaryngology Medical

  • Specialist
  • Palmdale, CA
  • NPI 1518376011
  NPD tax ID
• Golden State Otolaryngology Medical Corporation

  • Specialist
  • Lancaster, CA
  • NPI 1568660611
  NPD tax ID

Locations

Practitioners 3

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

• Ruwanthi Samaranayake Campano, M.D

  • Otolaryngology Physician
  • Palmdale, CA
  • NPI 1023018389
  Medicare reassignment Care Compare group Authorized official
• Sarah Robertson, NP

  • Family Nurse Practitioner
  • Palmdale, CA
  • NPI 1356690234
  Medicare reassignment Care Compare group NPD
• Denise Dru, MD

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Panorama City, CA
  • NPI 1548329154
  NPD (past)

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

{
    "created_epoch": "1205452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407801600000",
    "number": "1174794408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6558",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935396558",
            "telephone_number": "661-726-6277",
            "fax_number": "661-726-6291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 DRUMMOND AVE",
            "city": "RIDGECREST",
            "state": "CA",
            "postal_code": "935553187",
            "telephone_number": "760-371-7329",
            "fax_number": "661-726-6291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN STATE OTOLARYNGOLOGY MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-14",
        "last_updated": "2014-08-12",
        "status": "A",
        "authorized_official_last_name": "CAMPANO",
        "authorized_official_first_name": "RUWANTHI",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "661-726-6277",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A69121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ64933Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GSOMC-Billing",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Christopher Glenn, RBT
• Nicole Carmen Godett, PT
• Cecilia Jazmin Godinez Villa
• Annalise Karen Goh
• Emily Goldammer, CRNA
• Kayla Ann Gomez, PA
• Wayne Goode
• Nancy Goodwin
• Julianna Marie Gorduyn
• Stephanie Gougenheim, PT

• Specialist in Ridgecrest, CA
• Providers in Ridgecrest, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; 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.