Individual provider Active NPI

Glen Arnold Aquino, MD

  • Anesthesiology Physician
  • San Luis Obispo, CA
National Provider Identifier
1396985842
Registry record updated Jun 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A105808 Issued in CA
Practice address
1010 Murray Ave
San Luis Obispo, CA 93405-1806
Phone
(805) 928-1731
Fax
(805) 349-8160
NPI assigned
Feb 24, 2009
Last updated
Jun 11, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A105808 CA Primary

Addresses

Primary practice location

1010 Murray Ave
San Luis Obispo, CA 93405-1806

Mailing address

PO Box 6406
Santa Maria, CA 93456-6406
Phone (805) 928-1731

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120727000628 CA Practitioner - Anesthesiology 2062678568 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Anesthesiologists of the Central CoastGroup PAC ID 5597665018, 35 clinicians

Practice addresses (Care Compare)

1010 Murray Ave
San Luis Obispo, CA 93405-1806
Phone (805) 928-1731

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A105808CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Hospital Los Angeles Medical Group, Inc. CurrentSince Jul 1, 2012 Accepting new patients
Associated Anesthesiologists of the Central Coast Anesthesiology CurrentSince Sep 19, 2013 Accepting new patients
Valley Children's Medical Group Past Accepting new patients

Locations

4650 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 361-2122

4650 W Sunset Blvd
#3
Los Angeles, CA 90027
Phone (323) 361-5918

24757 Dept La Lockbox
Pasadena, CA 91185

921 Oak Park Blvd
Ste 101
Pismo Beach, CA 93449
Phone (805) 471-3353

1010 Murray Ave
Sn Luis Obisp, CA 93405
Phone (805) 546-7600

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1235433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370908800000",
    "number": "1396985842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6406",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934566406",
            "telephone_number": "805-928-1731",
            "fax_number": "805-349-8160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 MURRAY AVE",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934051806",
            "telephone_number": "805-928-1731",
            "fax_number": "805-349-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AQUINO",
        "first_name": "GLEN",
        "middle_name": "ARNOLD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-24",
        "last_updated": "2013-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A105808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.