NPIMap

Organization Active NPI

Core Anesthesia Provider Services PC

  • Anesthesiology Physician
  • Stockton, CA
National Provider Identifier
1538800388
Registry record updated Apr 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
CORE ANESTHESIA PROVIDER SERVICES PC
Practice address
36 W Yokuts Ave Ste 3
Stockton, CA 95207-5713
Phone
(209) 952-1189
NPI assigned
Apr 5, 2022
Last updated
Apr 5, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2022

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

Authorized official

Name
Brittany Boyer
Title
Credentialing Specialist
Phone
(209) 956-7732

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

36 W Yokuts Ave Ste 3
Stockton, CA 95207-5713

Mailing address

PO Box 7096
Stockton, CA 95267-0096
Phone (209) 956-7725

Other practice location 1

2423 W March Ln Ste 100
Stockton, CA 95207-8250
Phone (209) 956-7725

Other practice location 2

400 E Orangeburg Ave
Modesto, CA 95350-5342
Phone (209) 956-7732

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220705000130 CA Part B Supplier - Clinic/Group Practice 7719367093 Receives reassigned benefits from 21 practitioners
Practice locations: Stockton, CA

National Provider Directory

National Provider Directory

Locations

400 E Orangeburg Ave
Modesto, CA 95350
Phone (209) 522-6300

2423 W March Ln
Ste 100
Stockton, CA 95207

36 W Yokuts Ave
Ste 3
Stockton, CA 95207
Phone (209) 952-1189

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1538800388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7096",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952670096",
            "telephone_number": "209-956-7725",
            "fax_number": "209-956-7738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 W YOKUTS AVE STE 3",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075713",
            "telephone_number": "209-952-1189"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2423 W March Ln Ste 100",
            "address_purpose": "LOCATION",
            "city": "Stockton",
            "state": "CA",
            "postal_code": "952078250",
            "country_code": "US",
            "telephone_number": "209-956-7725",
            "fax_number": "209-956-7738",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 E Orangeburg Ave",
            "address_purpose": "LOCATION",
            "city": "Modesto",
            "state": "CA",
            "postal_code": "953505342",
            "country_code": "US",
            "telephone_number": "209-956-7732",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CORE ANESTHESIA PROVIDER SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "BOYER",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "209-956-7732"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.