Individual provider Active NPI

Sara Diane Whatley-Dustin, DO

  • Family Medicine Physician
  • Camarillo, CA
National Provider Identifier
1609165299
Registry record updated Sep 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A12381 Issued in CA
Practice address
64 E Daily Dr
Camarillo, CA 93010-5803
Phone
(805) 384-8071
Fax
(805) 437-8717
NPI assigned
Apr 4, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A12381 CA Primary

Addresses

Primary practice location

64 E Daily Dr
Camarillo, CA 93010-5803

Mailing address

3400 Data Dr
Attn Credentialing/Payer Enrollment
Rancho Cordova, CA 95670-7956

Other names 1

  • Sara Diane Whatley Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Sep 7, 2021 through Sep 7, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A12381CAMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1301875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1609165299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "address_2": "ATTN CREDENTIALING/PAYER ENROLLMENT",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 E DAILY DR",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930105803",
            "telephone_number": "805-384-8071",
            "fax_number": "805-437-8717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHATLEY-DUSTIN",
        "first_name": "SARA",
        "middle_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-04",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A12381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARA",
            "last_name": "WHATLEY",
            "middle_name": "DIANE",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Camarillo, CA

Sources for this page

Verify at the official NPI Registry.