San Luis Diagnostic Medical Associates

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

SAN LUIS DIAGNOSTIC MEDICAL ASSOCIATES

Practice address

1100 Monterey St
Suite 210
San Luis Obispo, CA 93401-3102

Phone

(805) 542-9700

Fax

(805) 542-0584

NPI assigned

Jan 25, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Gail L. Roberts

Title

Executive Director

Phone

(805) 542-9700

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598811580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 MONTEREY ST",
            "address_2": "SUITE 210",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013102",
            "telephone_number": "805-542-9700",
            "fax_number": "805-542-0584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 MONTEREY ST",
            "address_2": "SUITE 210",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013102",
            "telephone_number": "805-542-9700",
            "fax_number": "805-542-0584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN LUIS DIAGNOSTIC MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "805-542-9700",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0088380",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD ID NUMBER",
            "identifier": "ZZZ55471Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• San Lui Obispo Center for Change
• San Luis Ambulance Service, Inc.
• San Luis Chronic Pain Massage Therapy
• San Luis Coastal Unified School District
• San Luis Dermatology, Inc.
• San Luis Hospitalists a Medical Corporation
• San Luis Imaging Medical Group, Inc
• San Luis Internal Medicine Associates, a Medical Corporation
• San Luis Obispo
• San Luis Obispo Behavioral Health

• All providers in San Luis Obispo, CA
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.