Central Coast Regenerative Medicine Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CENTRAL COAST REGENERATIVE MEDICINE INC

Practice address

628 California Blvd Ste E
San Luis Obispo, CA 93401-2548

Phone

(805) 540-2010

NPI assigned

Dec 20, 2019

Reactivated

Apr 7, 2021

Organization subpart

No

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

Authorized official

Name

Ellexis E KhanNPI 1336671536

Title

Owner, Authorized Official

Phone

(530) 415-6549

Specialties & licenses 1

Addresses

Practitioners 2

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

• Ellexis Khan, M.D.

  • Sports Medicine (Family Medicine) Physician
  • Long Beach, CA
  • NPI 1336671536
  NPD Authorized official
• James Madison Spurlock IV, D.C.

  • Chiropractor
  • San Luis Obispo, CA
  • NPI 1326178278
  NPD

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

{
    "created_epoch": "1576800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619136000000",
    "number": "1649818626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 CALIFORNIA BLVD STE E",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012548",
            "telephone_number": "805-540-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 CALIFORNIA BLVD STE E",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012548",
            "telephone_number": "805-540-2010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL COAST REGENERATIVE MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-20",
        "last_updated": "2021-04-23",
        "certification_date": "2021-04-23",
        "deactivation_date": "2021-02-09",
        "reactivation_date": "2021-04-07",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "ELLEXIS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER, AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "530-415-6549"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Central Coast Pain Management Specialists, Inc.
• Central Coast Pathology Consultants, Inc
• Central Coast Pathology Consultants, Inc.
• Central Coast Pediatrics Inc
• Central Coast Psychotherapy Services, Inc.
• Central Coast Renal Care Inc
• Central Coast Rheumatology Medical Corp
• Central Coast Veterans Associates LLC
• Central Rehabilitation Clinic Inc
• Cep America - California

• Family Medicine Physician in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; 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.