NPIMap

Organization Active NPI

Santa Maria Gastroenterology Medical Group Inc.

  • Gastroenterology Physician
  • Santa Maria, CA
National Provider Identifier
1386971687
Registry record updated Jul 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
SANTA MARIA GASTROENTEROLOGY MEDICAL GROUP INC.
Practice address
1311 S Miller St
100
Santa Maria, CA 93454-6900
Phone
(805) 922-6991
Fax
(805) 922-7052
NPI assigned
Nov 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2012

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

Authorized official

Name
Dr. Eric W Jahnke, M.D.
Title
Partner
Phone
(805) 922-6991

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

1311 S Miller St
100
Santa Maria, CA 93454-6900

Mailing address

1311 S Miller St
100
Santa Maria, CA 93454-6900
Phone (805) 922-6991

Other identifiers 3

IdentifierTypeStateIssuer
DS163AOtherCAPTAN
CLM 00342820OtherCACLIA
1386971687MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101101001401 CA Part B Supplier - Clinic/Group Practice 6709070964 Receives reassigned benefits from 28 practitioners
Practice locations: Santa Maria, CA

National Provider Directory

National Provider Directory

Locations

354 S Halcyon Rd
Arroyo Grande, CA 93420
Phone (805) 423-2008

361 Town Ctr W
Ste 101
Santa Maria, CA 93458
Phone (805) 287-9107

361 Town Ctr W
Ste 103
Santa Maria, CA 93458

361 Town Ctr W
Santa Maria, CA 93458
Phone (805) 922-6581

1311 S Miller St
Ste 100
Santa Maria, CA 93454
Phone (805) 922-6991

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1257465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343001600000",
    "number": "1386971687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 S MILLER ST",
            "address_2": "100",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934546900",
            "telephone_number": "805-922-6991",
            "fax_number": "805-922-7052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 S MILLER ST",
            "address_2": "100",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934546900",
            "telephone_number": "805-922-6991",
            "fax_number": "805-922-7052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA MARIA GASTROENTEROLOGY MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-06",
        "last_updated": "2012-07-23",
        "status": "A",
        "authorized_official_last_name": "JAHNKE",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "805-922-6991",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "DS163A",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "CLM 00342820",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386971687",
            "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 23, 2012; 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.