Donald Waldrep, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

G75982 Issued in CA

Practice address

110 Jensen CT
Suite 1B
Thousand Oaks, CA 91360-7483

Phone

(805) 230-0030

Fax

(805) 230-2995

NPI assigned

Jan 2, 2007

Last updated

Mar 24, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

Medical University of South Carolina College of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Acute Care Surgery Medical Group IncGroup PAC ID 7214006816, 205 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Los Robles Hospital & Medical Center Hospital, Thousand Oaks, CA, CCN 050549
• Desert Regional Medical Center Hospital, Palm Springs, CA, CCN 050243

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Acute Care Surgery Medical Group, Inc.

  • Surgery Physician
  • Sacramento, CA
  • NPI 1700069549
  Medicare reassignment Care Compare group NPD
• Sacramento Advanced Laparoscopic Surgery

  dba Donald Waldrep, MD

  • Surgery Physician
  • Thousand Oaks, CA
  • NPI 1316395395
  Medicare reassignment Authorized official
• Surgical Affiliates of California

  • Surgery Physician
  • Los Banos, CA
  • NPI 1932440781
  Medicare reassignment NPD
• Sacramento Advanced Laparoscopic Surgery Associates

  • Surgical Physician Assistant
  • Roseville, CA
  • NPI 1447356290
  NPD (past) Authorized official
• Southern California Advanced Laparo Endoscopic Surgery

  • Surgery Physician
  • Thousand Oaks, CA
  • NPI 1649471061
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Desert Regional Medical Center, Inc.

  dba Desert Regional Medical Center

  • General Acute Care Hospital
  • Palm Springs, CA
  • NPI 1104856095
  Care Compare affiliation
• Los Robles Regional Medical Center

  dba Los Robles Hospital & Medical Center

  • General Acute Care Hospital
  • Thousand Oaks, CA
  • NPI 1306890389
  Care Compare affiliation

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458777600000",
    "number": "1679630446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 JENSEN CT",
            "address_2": "SUITE 1B",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913607483",
            "telephone_number": "805-230-0030",
            "fax_number": "805-230-2995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 JENSEN CT",
            "address_2": "SUITE 1B",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913607483",
            "telephone_number": "805-230-0030",
            "fax_number": "805-230-2995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDREP",
        "first_name": "DONALD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2016-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "G75982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tessa Waggoner, PT
• Hogan Wagner, BA
• Sean B Wagner, D.C.
• Jeff Waldberg, PT, MOMT
• Glenn Eric Waldman, M.D.
• Walgreen Co (Walgreens #07992)
• Sophia Julie Lynn Wall
• Erica Wallace
• Harvey I Wallack, M.D.
• Walmart Inc. (Walmart Pharmacy 10-3179)

• Surgery Physician in Thousand Oaks, CA
• Providers in Thousand Oaks, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.