NPIMap

Organization Active NPI

Stanislaus Anesthesia, Inc.

  • Anesthesiology Physician
  • Modesto, CA
National Provider Identifier
1679335632
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
STANISLAUS ANESTHESIA, INC.
Practice address
1421 Oakdale Rd
Modesto, CA 95355-3356
Phone
(831) 713-8877
NPI assigned
Jan 25, 2024
Last updated
Dec 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Authorized official

Name
Patrik Haley
Title
Administrator
Phone
(831) 713-8877

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

1421 Oakdale Rd
Modesto, CA 95355-3356

Mailing address

6355 Topanga Canyon Blvd Ste 430
Woodland Hills, CA 91367-2141
Phone (831) 713-8877

Other practice location 1

2900 Eureka Way
Redding, CA 96001-0220
Phone (530) 225-8700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250214001096 CA Part B Supplier - Clinic/Group Practice 6608306089 Receives reassigned benefits from 8 practitioners
Practice locations: Redding, CA

National Provider Directory

National Provider Directory

Locations

6355 Topanga Canyon Blvd
Ste 430
Woodland Hills, CA 91367

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1706140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1679335632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6355 TOPANGA CANYON BLVD STE 430",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913672141",
            "telephone_number": "831-713-8877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 OAKDALE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953553356",
            "telephone_number": "831-713-8877"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2900 Eureka Way",
            "address_purpose": "LOCATION",
            "city": "Redding",
            "state": "CA",
            "postal_code": "960010220",
            "country_code": "US",
            "telephone_number": "530-225-8700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STANISLAUS ANESTHESIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-25",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "HALEY",
        "authorized_official_first_name": "PATRIK",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "831-713-8877"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; 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.