Pismo Family Practice Medical Corporation a Ca Prof Medical Corp

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A0436 Issued in CA

Legal business name

PISMO FAMILY PRACTICE MEDICAL CORPORATION A CA PROF MEDICAL CORP

Practice address

575 Price St
Suite 101
Pismo Beach, CA 93449-2553

Phone

(805) 773-0707

Fax

(805) 773-2051

NPI assigned

Oct 31, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Wendy Eve Weiss, D.O.NPI 1609867738

Title

President

Phone

(805) 773-0707

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Pismo Family Practice Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wendy Eve Weiss, DO

  • Family Medicine Physician
  • Pismo Beach, CA
  • NPI 1609867738
  Medicare reassignment Authorized official
• Suzan Hillaire Williams, A.N.P.

  • Adult Health Nurse Practitioner
  • Pismo Beach, CA
  • NPI 1447238894
  Medicare reassignment NPD
• Jennifer Diaz, NP

  • Family Nurse Practitioner
  • Pismo Beach, CA
  • NPI 1013518711
  Medicare reassignment

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453680000000",
    "number": "1497746473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 PRICE ST",
            "address_2": "SUITE 101",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934492553",
            "telephone_number": "805-773-0707",
            "fax_number": "805-773-2051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 PRICE ST",
            "address_2": "SUITE 101",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934492553",
            "telephone_number": "805-773-0707",
            "fax_number": "805-773-2051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PISMO FAMILY PRACTICE MEDICAL CORPORATION A CA PROF MEDICAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2016-01-25",
        "status": "A",
        "authorized_official_last_name": "WEISS",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "EVE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-773-0707",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A0436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE CORPORATION NUMBER",
            "identifier": "C1962153",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP NUMBER",
            "identifier": "ZZZ48888Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0080750",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pismo Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kenneth A Peterson, OD
• Rachael Mary Elizabeth Pharr Larson, P.T.
• Physical Therapy Specialists PTS, Inc.
• Shahriar Pirouz, M.D.
• Pismo Beach Recovery Inc
• Praise Behavior Service Inc.
• Wendy Purviance
• Radiology Associates of San Luis Obispo
• Radiology Associates of San Luis Obispo
• Alexandra Renfrow

• Family Medicine Physician in Pismo Beach, CA
• Providers in Pismo Beach, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; 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.