NPIMap

Organization Active NPI

Ventana Health and Medical Center

  • Family Medicine Physician
  • Pismo Beach, CA
National Provider Identifier
1699758565
Registry record updated Nov 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2537515 Issued in CA
Legal business name
VENTANA HEALTH AND MEDICAL CENTER
Practice address
901 Oak Park Blvd
Suite 101
Pismo Beach, CA 93449-3216
Phone
(805) 489-2205
Fax
(805) 489-2206
NPI assigned
Nov 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2010

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

Authorized official

Name
Dr. Megan M Ellman, MD
Title
VP
Phone
(805) 489-2205

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 2537515 CA Primary

Addresses

Primary practice location

901 Oak Park Blvd
Suite 101
Pismo Beach, CA 93449-3216

Mailing address

PO Box 1410
Pismo Beach, CA 93448-1410
Phone (805) 489-2205

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ07475ZOtherCABLUE SHIELD OF CALIFORNIA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289347200000",
    "number": "1699758565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1410",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934481410",
            "telephone_number": "805-489-2205",
            "fax_number": "805-489-2206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 OAK PARK BLVD",
            "address_2": "SUITE 101",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493216",
            "telephone_number": "805-489-2205",
            "fax_number": "805-489-2206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VENTANA HEALTH AND MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-23",
        "last_updated": "2010-11-10",
        "status": "A",
        "authorized_official_last_name": "ELLMAN",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "805-489-2205",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "2537515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "ZZZ07475Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pismo Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2010; 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.