Monterey Bay Heart Center

Primary specialty

SpecialistTaxonomy code 174400000X

License

G55040 Issued in CA

Legal business name

MONTEREY BAY HEART CENTER

Practice address

1595 Soquel Dr Ste 360
Santa Cruz, CA 95065-1723

Phone

(831) 479-9500

NPI assigned

Apr 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Benjamin N Potkin, M.D.NPI 1740335090

Title

Ceo

Phone

(831) 479-9500

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Watsonville Surgeons Group LLC

  • Ambulatory Surgical Clinic/Center
  • Freedom, CA
  • NPI 1790799047

  Member Of

  NPD member

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 7

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

• Benjamin N Potkin, M.D.

  • Cardiovascular Disease Physician
  • Santa Cruz, CA
  • NPI 1740335090

  CA

  Medicare reassignment Care Compare group NPD Authorized official
• Jay Austin Johnson, M.D.

  • Cardiovascular Disease Physician
  • Santa Cruz, CA
  • NPI 1699810697

  CA

  Medicare reassignment Care Compare group
• Theodore Chow, MD, FACC

  • Clinical Cardiac Electrophysiology Physician
  • Mountain View, CA
  • NPI 1104803048

  CA

  Medicare reassignment NPD
• John M Koostra, M.D.

  • Pulmonary Disease Physician
  • Monterey, CA
  • NPI 1922058437
  NPD (past)
• Eun-Jung Park, MD

  • Internal Medicine Physician
  • Monterey, CA
  • NPI 1598866162
  NPD (past)
• Navaid Asad, M.D.

  • Cardiovascular Disease Physician
  • Kailua Kona, HI
  • NPI 1104807684
  NPD (past)
• Robert F. Sprung Jr., M.D.

  • Specialist
  • Farmington, NM
  • NPI 1255314837
  NPD (past)

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1720100480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1595 SOQUEL DR STE 360",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651723",
            "telephone_number": "831-479-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1595 SOQUEL DR STE 360",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651723",
            "telephone_number": "831-479-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTEREY BAY HEART CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A",
        "authorized_official_last_name": "POTKIN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "831-479-9500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G55040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0071630",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dayna A Montana
• Emily Montano
• Mary-an Montelongo, SCHOOL COUNSELOR PPS
• Amanda Monteon
• Monterey Bay Gastroenterology, PC
• Monterey Bay Urology Associates
• Jessica Montero
• Matthew Geronimo Montes, ACSW
• Autumn Montez
• Courtney Regina Montgomery, NP

• All providers in Santa Cruz, CA
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.