Halcyon Laser & Surgery Center, Inc.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

HALCYON LASER & SURGERY CENTER, INC.

Practice address

303 S Halcyon Rd
Arroyo Grande, CA 93420-3817

Phone

(805) 489-8254

Fax

(805) 474-1997

NPI assigned

Apr 19, 2006

Last updated

Jul 16, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sanja Brewer

Title

Director of Operations

Phone

(805) 541-1342

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Halcyon Laser and Surgery Center IncCCN 05C0001344

Medicare certification status

ActiveFrom the Provider of Services file

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184544000000",
    "number": "1396700753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 S HALCYON RD",
            "city": "ARROYO GRANDE",
            "state": "CA",
            "postal_code": "934203817",
            "telephone_number": "805-489-8254",
            "fax_number": "805-474-1997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 S HALCYON RD",
            "city": "ARROYO GRANDE",
            "state": "CA",
            "postal_code": "934203817",
            "telephone_number": "805-489-8254",
            "fax_number": "805-474-1997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALCYON LASER & SURGERY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-19",
        "last_updated": "2007-07-16",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "SANJA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "805-541-1342"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF CALIFORNIA",
            "identifier": "051344",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SUR01344F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA",
            "identifier": "ZZZH4003Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Jude Grant, MA, CCC, COM
• Gregory S Pritchett, DDS Inc
• Nickolas Peter Grimes, DPM
• James Guerra, P.T.
• Jessica Lynn Gust, MS, RDN
• Arlan Hall
• Donald R Halsey
• Heather G Hamaguchi, PT
• Betty Ann Hamilton, P.T.
• Kelli Thompson Hamma

• Ambulatory Surgical Clinic/Center in Arroyo Grande, CA
• Providers in Arroyo Grande, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.