Individual provider Active NPI

Johannes A. Haar, M.D.

  • Family Medicine Physician
  • Pismo Beach, CA
National Provider Identifier
1376526657
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A61720 Issued in CA
Practice address
877 Oak Park Blvd
Pismo Beach, CA 93449-3292
Phone
(805) 474-8450
Fax
(805) 474-8454
NPI assigned
Nov 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A61720 CA Primary

Addresses

Primary practice location

877 Oak Park Blvd
Pismo Beach, CA 93449-3292

Mailing address

877 Oak Park Blvd
Pismo Beach, CA 93449-3292
Phone (805) 474-8450

Other identifiers 2

IdentifierTypeStateIssuer
7639244OtherAETNA
A61720OtherCALICENSE #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A61720CAMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1376526657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 OAK PARK BLVD",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493292",
            "telephone_number": "805-474-8450",
            "fax_number": "805-474-8454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "877 OAK PARK BLVD",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493292",
            "telephone_number": "805-474-8450",
            "fax_number": "805-474-8454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAAR",
        "first_name": "JOHANNES",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A61720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7639244",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "A61720",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pismo Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.