Individual provider Active NPI

Andrew M. Fairburn, PA-C

  • Physician Assistant
  • Santa Maria, CA
National Provider Identifier
1245442342
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA19301 Issued in CA
Practice address
430 S Blosser Rd
Santa Maria, CA 93458-4908
Phone
(805) 361-8900
Fax
(805) 361-8990
NPI assigned
May 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA19301 CA Primary

Addresses

Primary practice location

430 S Blosser Rd
Santa Maria, CA 93458-4908

Mailing address

2050 S Blosser Rd
Santa Maria, CA 93458-7310
Phone (805) 361-8030

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100924000465 CA Practitioner - Physician Assistant 2163548330 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
19301CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Centers of the Central Coast Inc CurrentSince Mar 15, 2015 Accepting new patients
Community Health Centers of the Central Coast Inc Current Accepting new patients
Community Health Centers of the Central Coast Inc CurrentSince Mar 15, 2015 Accepting new patients
Family Healthcare Network CurrentSince Jul 11, 2010 Accepting new patients
Family Healthcare Network CurrentSince Jul 11, 2010 Accepting new patients
Keith Mark Gross MD Inc Past Accepting new patients

Locations

1107 W Poplar Ave
Porterville, CA 93257
Phone (559) 781-7242

430 S Blosser Rd
Santa Maria, CA 93458
Phone (805) 361-8900

2801 Santa Maria Way
Bldg A
Santa Maria, CA 93455
Phone (805) 938-9200

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

305 E Center Ave
Visalia, CA 93291
Phone (559) 737-4792

201 E Lakeview Ave
Woodlake, CA 93286
Phone (559) 564-0100

Interoperability endpoints

  • Direct secure messaging: andrew.fairburn.1@17363.direct.athenahealth.com

Organizations & group practices 8

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": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1245442342",
    "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": "805-361-8030",
            "fax_number": "805-361-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 S BLOSSER RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934584908",
            "telephone_number": "805-361-8900",
            "fax_number": "805-361-8990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBURN",
        "first_name": "ANDREW",
        "middle_name": "M.",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA19301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Maria, CA

Sources for this page

Verify at the official NPI Registry.