NPIMap

Individual provider Active NPI

Atipon Kangwanpornsiri, M.D.

  • Internal Medicine Physician
  • Nipomo, CA
National Provider Identifier
1487854816
Registry record updated Jun 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A118291 Issued in CA
Practice address
150 Tejas PL
Nipomo, CA 93444-9123
Phone
(805) 929-3211
Fax
(805) 929-6354
NPI assigned
Jul 24, 2007
Last updated
Jun 30, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A118291 CA Primary
Nephrology Physician 207RN0300X 36759 SC

Addresses

Primary practice location

150 Tejas PL
Nipomo, CA 93444-9123

Mailing address

2050 S Blosser Rd
Santa Maria, CA 93458-7310
Phone (805) 361-8030

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
I20121107000688 CA Practitioner - Internal MedicinePractitioner - Diagnostic Radiology 8729239330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Health Centers of the Central Coast IncGroup PAC ID 7416868120, shared by 23 NPIs, 74 clinicians

Practice addresses (Care Compare)

150 Tejas PL
Nipomo, CA 93444-9123
Phone (805) 929-3211

2801 Santa Maria Way
Santa Maria, CA 93455-2118

430 S Blosser Rd
Santa Maria, CA 93458-4908
Phone (805) 361-8400

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Centers of the Central Coast Inc Current Accepting new patients
Community Health Centers of the Central Coast Inc CurrentSince Feb 9, 2018 Accepting new patients
Community Health Centers of the Central Coast Inc Current Accepting new patients
Community Health Centers of the Central Coast Inc CurrentSince Feb 9, 2018 Accepting new patients
Community Health Center of the Central Coast Inc Past Accepting new patients
Dignity Health Past Accepting new patients

Locations

7512 Morro Rd
Atascadero, CA 93422
Phone (805) 461-3344

150 Tejas Pl
Nipomo, CA 93444
Phone (805) 929-3254

150 Tejas Pl
Ste 1
Nipomo, CA 93444

2050 S Blosser Rd
Santa Maria, CA 93458
Phone (805) 361-8014

2801 Santa Maria Way
Santa Maria, CA 93455
Phone (805) 934-5400

1551 Bishop St
Ste A160
Sn Luis Obisp, CA 93401
Phone (805) 781-4230

325 Posada Ln
Templeton, CA 93465
Phone (805) 239-0644

Organizations & group practices 6

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 5

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": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1487854816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 S BLOSSER RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934587310",
            "telephone_number": "805-361-8030",
            "fax_number": "805-361-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 TEJAS PL",
            "city": "NIPOMO",
            "state": "CA",
            "postal_code": "934449123",
            "telephone_number": "805-929-3211",
            "fax_number": "805-929-6354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANGWANPORNSIRI",
        "first_name": "ATIPON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-24",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A118291",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "SC",
            "license": "36759",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nipomo, CA

Sources for this page

Verify at the official NPI Registry.