Individual provider Active NPI

Emily P Otto, NP

  • Acute Care Nurse Practitioner
  • Santa Cruz, CA
National Provider Identifier
1619401460
Registry record updated Oct 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
95007121 Issued in CA
Practice address
1555 Soquel Dr
Santa Cruz, CA 95065-1705
Phone
(831) 462-7581
NPI assigned
Apr 19, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 632238 CA
Acute Care Nurse Practitioner 363LA2100X 95007121 CA Primary

Addresses

Primary practice location

1555 Soquel Dr
Santa Cruz, CA 95065-1705

Mailing address

1555 Soquel Dr
Santa Cruz, CA 95065-1705

Other identifiers 1

IdentifierTypeStateIssuer
269329MedicaidCA

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
I20171018002954 CA Practitioner - Nurse Practitioner 8628344629 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
632238CAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California Current Accepting new patients
Cep America-California CurrentSince Sep 9, 2017 Accepting new patients
County of Monterey Behavioral Health CurrentSince May 13, 2022 Accepting new patients
Cep America - California CurrentSince Sep 9, 2017 Accepting new patients
County of Monterey CurrentSince May 13, 2022 Accepting new patients

Locations

2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

1441 Constitution Blvd
Salinas, CA 93906
Phone (831) 261-8090

1555 Soquel Dr
Santa Cruz, CA 95065
Phone (831) 462-7700

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.

NPI Registry JSON

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

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508630400000",
    "number": "1619401460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 SOQUEL DR",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 SOQUEL DR",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651705",
            "telephone_number": "831-462-7581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTO",
        "first_name": "EMILY",
        "middle_name": "P",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-19",
        "last_updated": "2017-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "632238",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95007121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269329",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

Verify at the official NPI Registry.