Individual provider Active NPI

Anthony Graves

  • Family Nurse Practitioner
  • Paso Robles, CA
National Provider Identifier
1417341330
Registry record updated Jun 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95002609 Issued in CA
Practice address
2120 Golden Hill Rd Ste 102
Paso Robles, CA 93446-7048
Phone
(805) 434-2900
Fax
(805) 434-2928
NPI assigned
Mar 28, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95002609 CA Primary

Addresses

Primary practice location

2120 Golden Hill Rd Ste 102
Paso Robles, CA 93446-7048

Mailing address

PO Box 3341
Paso Robles, CA 93447-3341

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160523001754 CA Practitioner - Nurse Practitioner 6507155058 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Las Tablas Medical Group IncGroup PAC ID 7012011141, 3 clinicians

Practice addresses (Care Compare)

2120 Golden Hill Rd
Suite 102
Paso Robles, CA 93446-7048
Phone (805) 434-2900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95002609CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Department of State Hospitals CurrentSince Apr 11, 2016 Accepting new patients
Department of State Hospitals Current Accepting new patients

Locations

10333 El Camino Real
Atascadero, CA 93422
Phone (805) 468-2000

1215 O St
#3
Sacramento, CA 95814
Phone (916) 651-2805

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DBFJAA/Endpoint/DBFJAA

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1427500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780876800000",
    "number": "1417341330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3341",
            "city": "PASO ROBLES",
            "state": "CA",
            "postal_code": "934473341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 GOLDEN HILL RD STE 102",
            "city": "PASO ROBLES",
            "state": "CA",
            "postal_code": "934467048",
            "telephone_number": "805-434-2900",
            "fax_number": "805-434-2928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVES",
        "first_name": "ANTHONY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-28",
        "last_updated": "2026-06-08",
        "certification_date": "2026-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95002609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paso Robles, CA

Sources for this page

Verify at the official NPI Registry.