NPIMap

Organization Active NPI

Medstat Inc

  • Family Medicine Physician
  • Port Hueneme, CA
National Provider Identifier
1609362227
Registry record updated Dec 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEDSTAT INC
Practice address
430 Park Ave
Port Hueneme, CA 93041-2553
Phone
(805) 487-3881
Fax
(561) 286-5137
NPI assigned
Jul 6, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2023

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

Authorized official

Name
Gregorio L De Grano, NP
Title
Ceo
Phone
(818) 516-8066

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary
Clinic/Center 261Q00000X

Addresses

Primary practice location

430 Park Ave
Port Hueneme, CA 93041-2553

Mailing address

430 Park Ave
Port Hueneme, CA 93041-2553
Phone (805) 487-3881

National Provider Directory

National Provider Directory

Locations

430 Park Ave
Port Hueneme, CA 93041
Phone (805) 487-3881

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1530835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703635200000",
    "number": "1609362227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 PARK AVE",
            "city": "PORT HUENEME",
            "state": "CA",
            "postal_code": "930412553",
            "telephone_number": "805-487-3881",
            "fax_number": "561-286-5137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 PARK AVE",
            "city": "PORT HUENEME",
            "state": "CA",
            "postal_code": "930412553",
            "telephone_number": "805-487-3881",
            "fax_number": "561-286-5137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSTAT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-06",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A",
        "authorized_official_last_name": "DE GRANO",
        "authorized_official_first_name": "GREGORIO",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-516-8066",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Hueneme, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; 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.