NPIMap

Individual provider Active NPI

Laura Theis, M.D.

  • Family Medicine Physician
  • Santa Maria, CA
National Provider Identifier
1417954017
Registry record updated Feb 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A68947 Issued in CA
Practice address
821 E Chapel St Ste 103
Santa Maria, CA 93454-4618
Phone
(805) 310-5330
Fax
(805) 310-5339
NPI assigned
Jun 28, 2005
Last updated
Feb 23, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2024

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 A68947 CA Primary

Addresses

Primary practice location

821 E Chapel St Ste 103
Santa Maria, CA 93454-4618

Mailing address

821 E Chapel St Ste 103
Santa Maria, CA 93454-4618
Phone (805) 310-5330

Other practice location 1

220 S Palisade Dr
Suite 104B
Santa Maria, CA 93454-8902
Phone (805) 925-2521

Other names 1

  • Dr. Laura Kark Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050926000808 CA Practitioner - Family Practice 3870527146 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rush Medical College of Rush University, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

821 E Chapel St
Suite 103
Santa Maria, CA 93454-4618
Phone (805) 310-5330

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A68947CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Coast Family Care Medical Associates, Inc. Family Medicine CurrentSince Oct 1, 2005 Accepting new patients
Central Coast Family Care Medical Associates, Inc Family Medicine CurrentSince Oct 1, 2005 Accepting new patients
Central Coast Family Care Medical Associates, Inc Family Medicine Current Accepting new patients
Central Coast Family Care Medical Associates, Inc Family Medicine Past Accepting new patients
Dignity Health Past Accepting new patients

Locations

220 S Palisade Dr
Ste 104
Santa Maria, CA 93454
Phone (805) 737-5706

220 S Palisade Dr
Ste 104B
Santa Maria, CA 93454
Phone (805) 925-2521

821 E Chapel St
Ste 103
Santa Maria, CA 93454
Phone (805) 310-5330

821 E Chapel St
Ste 203
Santa Maria, CA 93454
Phone (805) 925-5334

915 E Stowell Rd
Ste B
Santa Maria, CA 93454
Phone (805) 938-7424

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

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": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708646400000",
    "number": "1417954017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 E CHAPEL ST STE 103",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934544618",
            "telephone_number": "805-310-5330",
            "fax_number": "805-310-5339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 E CHAPEL ST STE 103",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934544618",
            "telephone_number": "805-310-5330",
            "fax_number": "805-310-5339"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "220 S Palisade Dr",
            "address_2": "Suite 104B",
            "address_purpose": "LOCATION",
            "city": "Santa Maria",
            "state": "CA",
            "postal_code": "934548902",
            "country_code": "US",
            "telephone_number": "805-925-2521",
            "fax_number": "805-925-2821",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEIS",
        "first_name": "LAURA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-28",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A68947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "KARK",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Santa Maria, CA

Sources for this page

Verify at the official NPI Registry.