NPIMap

Organization Active NPI

Golden State Providers, a Medical Corporation

  • Multi-Specialty Clinic/Center
  • Moorpark, CA
National Provider Identifier
1366859449
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
GOLDEN STATE PROVIDERS, A MEDICAL CORPORATION
Practice address
865 Patriot Dr Ste 203
Moorpark, CA 93021-3405
Phone
(805) 370-4684
Fax
(844) 748-4623
NPI assigned
Jul 21, 2014
Last updated
Oct 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Authorized official

Name
Dr. Saba Habis, MD
Title
Authorized Official
Phone
(805) 852-9100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

865 Patriot Dr Ste 203
Moorpark, CA 93021-3405

Mailing address

2000 Health Park Dr
Brentwood, TN 37027-4525
Phone (615) 373-7600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160223000539 CA Part B Supplier - Clinic/Group Practice 7012212475 Receives reassigned benefits from 53 practitioners
Practice locations: San Jose, CA; West Hills, CA; Thousand Oaks, CA; Riverside, CA; Moorpark, CA; Loma Linda, CA

National Provider Directory

National Provider Directory

Locations

865 Patriot Dr
Ste 203
Moorpark, CA 93021
Phone (805) 370-4684

225 N Jackson Ave
#501
San Jose, CA 95116

225 N Jackson Ave
Ste 501
San Jose, CA 95116
Phone (408) 254-5292

7320 Woodlake Ave
Ste 110
West Hills, CA 91307
Phone (805) 852-9100

Practitioners & affiliated clinicians

Practitioners 58

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 58

NPI Registry JSON

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

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604016000000",
    "number": "1366859449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274525",
            "telephone_number": "615-373-7600",
            "fax_number": "866-346-1426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 PATRIOT DR STE 203",
            "city": "MOORPARK",
            "state": "CA",
            "postal_code": "930213405",
            "telephone_number": "805-370-4684",
            "fax_number": "844-748-4623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN STATE PROVIDERS, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-21",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A",
        "authorized_official_last_name": "HABIS",
        "authorized_official_first_name": "SABA",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "805-852-9100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorpark, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; 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.