NPIMap

Organization Active NPI

County of San Luis Obispo

  • Adolescent and Children Mental Health Clinic/Center
  • San Luis Obispo, CA
National Provider Identifier
1295059368
Registry record updated Aug 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
COUNTY OF SAN LUIS OBISPO
Practice address
2925 McMillan Ave Ste 108
San Luis Obispo, CA 93401-6765
Phone
(805) 781-4700
Fax
(805) 781-1273
NPI assigned
Mar 18, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2013

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

Authorized official

Name
M. Daisy Ilano, M.D.
Title
Medical Director
Phone
(805) 781-4700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

2925 McMillan Ave Ste 108
San Luis Obispo, CA 93401-6765

Mailing address

2178 Johnson Ave
San Luis Obispo, CA 93401-4535
Phone (805) 781-4700

Other identifiers 1

IdentifierTypeStateIssuer
4083MedicaidCA

Other names 1

  • Martha's Place Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050407000794 CA Part B Supplier - Clinic/Group Practice 9032020094 Receives reassigned benefits from 32 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Arroyo Grande, CA; San Luis Obispo, CA; Paso Robles, CA; Grover Beach, CA; Atascadero, CA

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Tax ID family
San Luis Obispo General78 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 2

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": "1268870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377129600000",
    "number": "1295059368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2178 JOHNSON AVE",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014535",
            "telephone_number": "805-781-4700",
            "fax_number": "805-781-1273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 MCMILLAN AVE STE 108",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016765",
            "telephone_number": "805-781-4700",
            "fax_number": "805-781-1273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SAN LUIS OBISPO",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-18",
        "last_updated": "2013-08-22",
        "status": "A",
        "authorized_official_last_name": "ILANO",
        "authorized_official_first_name": "M. DAISY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "805-781-4700",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4083",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Martha's Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2013; 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.