NPIMap

Organization Active NPI

Associated Anesthesiologists of the Central Coast

  • Anesthesiology Physician
  • San Luis Obispo, CA
National Provider Identifier
1619963576
Registry record updated May 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
ASSOCIATED ANESTHESIOLOGISTS OF THE CENTRAL COAST
Practice address
1010 Murray St
San Luis Obispo, CA 93405
Phone
(805) 928-1731
Fax
(805) 349-8160
NPI assigned
Sep 26, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2018

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

Authorized official

Name
Bob Hetzel
Title
Manager
Phone
(805) 550-1074

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

1010 Murray St
San Luis Obispo, CA 93405

Mailing address

PO Box 6406
Santa Maria, CA 93456-6406
Phone (805) 928-1731

Other identifiers 2

IdentifierTypeStateIssuer
GR0084310MedicaidCA
ZZZ57363ZOtherCABLUE SHIELD GROUP PROVIDE

Other names 1

  • COASTAL ANESTHESIOLOGY MEDICAL ASSOCIATES Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040112000097 CA Part B Supplier - Clinic/Group Practice 5597665018 Receives reassigned benefits from 44 practitioners
Practice locations: San Luis Obispo, CA; Templeton, CA; Arroyo Grande, CA; Pismo Beach, CA

National Provider Directory

National Provider Directory

Locations

24757 Dept La Lockbox
Pasadena, CA 91185

1105 E Foster Rd
Santa Maria, CA 93455

2400 N Main St
Lowr
East Peoria, IL 61611

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)…

Practitioners & affiliated clinicians

Practitioners 50

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

View all 50

NPI Registry JSON

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526515200000",
    "number": "1619963576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6406",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934566406",
            "telephone_number": "805-928-1731",
            "fax_number": "805-349-8160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 MURRAY ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "93405",
            "telephone_number": "805-928-1731",
            "fax_number": "805-349-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED ANESTHESIOLOGISTS OF THE CENTRAL COAST",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-26",
        "last_updated": "2018-05-17",
        "status": "A",
        "authorized_official_last_name": "HETZEL",
        "authorized_official_first_name": "BOB",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "805-550-1074"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0084310",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP PROVIDE",
            "identifier": "ZZZ57363Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COASTAL ANESTHESIOLOGY MEDICAL ASSOCIATES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "COASTAL ANESTHESIOLOGY MEDICAL ASSOCIATES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.