Organization Active NPI

Paul Luther MD, a Professional Corporation

  • Psychiatry Physician
  • Santa Cruz, CA
National Provider Identifier
1174833669
Registry record updated Oct 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A030758 Issued in CA
Legal business name
PAUL LUTHER MD, A PROFESSIONAL CORPORATION
Practice address
1663 Dominican Way
Suite 214
Santa Cruz, CA 95065-1527
Phone
(831) 809-6766
NPI assigned
Oct 18, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2010

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

Authorized official

Name
Dr. Paul K Luther, MDNPI 1437184660
Title
Owner
Phone
(831) 809-6766

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
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X A030758 CA Primary

Addresses

Primary practice location

1663 Dominican Way
Suite 214
Santa Cruz, CA 95065-1527

Mailing address

1663 Dominican Way
Suite 214
Santa Cruz, CA 95065-1527
Phone (831) 809-6766

Other identifiers 1

IdentifierTypeStateIssuer
00A307580MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200512000278 CA Part B Supplier - Clinic/Group Practice 6103257902 Receives reassigned benefits from 1 practitioner
Practice locations: Santa Cruz, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1287360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287360000000",
    "number": "1174833669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1663 DOMINICAN WAY",
            "address_2": "SUITE 214",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651527",
            "telephone_number": "831-809-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1663 DOMINICAN WAY",
            "address_2": "SUITE 214",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651527",
            "telephone_number": "831-809-6766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL LUTHER MD, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-18",
        "last_updated": "2010-10-18",
        "status": "A",
        "authorized_official_last_name": "LUTHER",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "831-809-6766",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A030758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A307580",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; 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.