Individual provider Active NPI

Jeanette Gudino

  • Physician Assistant
  • Santa Maria, CA
National Provider Identifier
1538883293
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA62417 Issued in CA
Practice address
5075 S Bradley Rd Ste 131
Santa Maria, CA 93455-5077
Phone
(805) 332-8155
Fax
(805) 332-8156
NPI assigned
Sep 27, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA62417 CA Primary

Addresses

Primary practice location

5075 S Bradley Rd Ste 131
Santa Maria, CA 93455-5077

Mailing address

5075 S Bradley Rd Ste 131
Santa Maria, CA 93455-5077
Phone (805) 332-8155

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
I20230623002167 CA Practitioner - Physician Assistant 3577921592 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific Central Coast Health CentersGroup PAC ID 9739091364, 247 clinicians

Practice addresses (Care Compare)

1510 E Main St
Suite 104 C
Santa Maria, CA 93454-4825
Phone (805) 349-8514

5075 S Bradley Rd
Suite 131
Santa Maria, CA 93455-5077
Phone (805) 332-8155

Hospital & facility affiliations

  • Marian Regional Medical Center Hospital, Santa Maria, CA, CCN 050107
  • French Hospital Medical Center Hospital, San Luis Obispo, CA, CCN 050232

Merit-based Incentive Payment System (MIPS)

Final score
99.64 of 100Reported as apm
Quality
86.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
62417CAMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
PA62417CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Central Coast Health Centers CurrentSince Aug 7, 2023 Accepting new patients
Pacific Central Coast Health Centers CurrentSince Aug 7, 2023 Accepting new patients
Pacific Central Coast Health Centers Past Accepting new patients
Pacific Central Coast Health Centers Past Accepting new patients

Locations

500 Old River Rd
Ste 200
Bakersfield, CA 93311
Phone (661) 663-6429

2901 N Ventura Rd
Ste 110
Oxnard, CA 93036
Phone (805) 981-6163

5075 S Bradley Rd
Ste 131
Santa Maria, CA 93455
Phone (805) 332-8155

1414 E Main St
Ste 201
Santa Maria, CA 93454
Phone (805) 739-3112

1510 E Main St
Ste 104C
Santa Maria, CA 93454
Phone (805) 349-8514

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1664236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1538883293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5075 S BRADLEY RD STE 131",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934555077",
            "telephone_number": "805-332-8155",
            "fax_number": "805-332-8156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5075 S BRADLEY RD STE 131",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934555077",
            "telephone_number": "805-332-8155",
            "fax_number": "805-332-8156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUDINO",
        "first_name": "JEANETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-27",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA62417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Maria, CA

Sources for this page

Verify at the official NPI Registry.