Paul C. Reisser, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G32734 Issued in CA

Practice address

2100 Lynn Rd Ste 215
Thousand Oaks, CA 91360-8038

Phone

(805) 497-4974

Fax

(805) 496-7636

NPI assigned

Oct 16, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: paul.reisser.1@15456.direct.athenahealth.com

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485734400000",
    "number": "1306926142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 LYNN RD",
            "address_2": "STE 215",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913608038",
            "telephone_number": "805-497-4974",
            "fax_number": "805-496-7636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 LYNN RD STE 215",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913608038",
            "telephone_number": "805-497-4974",
            "fax_number": "805-496-7636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REISSER",
        "first_name": "PAUL",
        "middle_name": "C.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2017-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G32734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "W591",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Redemptio LLC
• Danielle Reed, BA
• Regents of the University of California
• Stephen J. Reidy, M.D.
• Elizabeth Anne Reiss, M.S., CCC-SLP
• Teresa K. Reisser, LMFT
• Patrick J Reiten, M.D.
• Renaissance Asthetic Laser and Vein Institute, a Medical Corporation
• Reseda Prosthetics, Inc.
• Gordon Philip Reuben, MD

• Family Medicine Physician in Thousand Oaks, CA
• Providers in Thousand Oaks, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.