NPIMap

Organization Active NPI

The Pediatric Specialists Medical Group, Inc.

  • Pediatrics Physician
  • Arroyo Grande, CA
National Provider Identifier
1700964665
Registry record updated Feb 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
55326 Issued in CA
Legal business name
THE PEDIATRIC SPECIALISTS MEDICAL GROUP, INC.
Practice address
138 W Branch St
Suite a
Arroyo Grande, CA 93420-2611
Phone
(805) 481-3166
Fax
(805) 481-8237
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2008

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

Authorized official

Name
Dr. Susan H. Hoffman, M.D.
Title
Owner
Phone
(805) 481-3166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 55326 CA Primary

Addresses

Primary practice location

138 W Branch St
Suite a
Arroyo Grande, CA 93420-2611

Mailing address

138 W Branch St
Suite a
Arroyo Grande, CA 93420-2611
Phone (805) 481-3166

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ50949YOtherCABLUE SHIELD
GR0105730MedicaidCA

Other names 1

  • Pediatric Specialists Doing business as

National Provider Directory

National Provider Directory

Locations

138 W Branch St
Ste A
Arroyo Grande, CA 93420
Phone (805) 481-3166

Practitioners & affiliated clinicians

Practitioners 1

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": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204156800000",
    "number": "1700964665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 W BRANCH ST",
            "address_2": "SUITE A",
            "city": "ARROYO GRANDE",
            "state": "CA",
            "postal_code": "934202611",
            "telephone_number": "805-481-3166",
            "fax_number": "805-481-8237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 W BRANCH ST",
            "address_2": "SUITE A",
            "city": "ARROYO GRANDE",
            "state": "CA",
            "postal_code": "934202611",
            "telephone_number": "805-481-3166",
            "fax_number": "805-481-8237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PEDIATRIC SPECIALISTS MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-02-28",
        "status": "A",
        "authorized_official_last_name": "HOFFMAN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-481-3166",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "55326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ50949Y",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0105730",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Arroyo Grande, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2008; 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.