Active NPI
Sara Diane Whatley-Dustin, DO
- Family Medicine Physician
- Camarillo, CA
National Provider Identifier
1609165299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 20A12381
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
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
- 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.
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A12381 | CA | MD | Family 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.