NPIMap

Organization Active NPI

California Retina Consultants

  • Retina Specialist (Ophthalmology) Physician
  • Santa Maria, CA
National Provider Identifier
1265575591
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
CALIFORNIA RETINA CONSULTANTS
Practice address
1510 E Main St
Suite 103
Santa Maria, CA 93454-4825
Phone
(805) 922-2068
Fax
(805) 880-5915
NPI assigned
Feb 15, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Robert L Avery, MDNPI 1700985496
Title
Ceo
Phone
(805) 963-1648

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU
Retina Specialist (Ophthalmology) Physician 207WX0107X NU Primary

Addresses

Primary practice location

1510 E Main St
Suite 103
Santa Maria, CA 93454-4825

Mailing address

525 E Micheltorena St
Suite a
Santa Barbara, CA 93103-2254
Phone (805) 963-1648

Other identifiers 2

IdentifierTypeStateIssuer
GR0091151MedicaidCA
ZZZ60752ZOtherCABLUE SHIELD GROUP #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040408001116 CA Part B Supplier - Clinic/Group Practice 6608860135 Receives reassigned benefits from 16 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Palmdale, CA; Westlake Village, CA; Valencia, CA; Simi Valley, CA; Santa Maria, CA; San Luis Obispo, CA; Paso Robles, CA; Oxnard, CA…

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2110624California Retina Consultants1510 E Main St Ste 103, Santa Maria, CA 93454Certificate of waiverMar 20, 2028

National Provider Directory

National Provider Directory
Tax ID family
California Retina Consultants10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1265575591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 E MICHELTORENA ST",
            "address_2": "SUITE A",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "931032254",
            "telephone_number": "805-963-1648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 E MAIN ST",
            "address_2": "SUITE 103",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934544825",
            "telephone_number": "805-922-2068",
            "fax_number": "805-880-5915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA RETINA CONSULTANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "AVERY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "805-963-1648",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0091151",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP #",
            "identifier": "ZZZ60752Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Maria, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.