NPIMap

Organization Active NPI

Central Coast Chest Consultants a Medical Corporation

Doing business as Central Coast Chest Consultants Medical Corporation

  • Critical Care Medicine (Internal Medicine) Physician
  • San Luis Obispo, CA
National Provider Identifier
1740267574
Registry record updated Jun 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
2070377 Issued in CA
Legal business name
CENTRAL COAST CHEST CONSULTANTS A MEDICAL CORPORATION
Doing business as
Central Coast Chest Consultants Medical Corporation
Practice address
1428 Phillips LN
Suite 203
San Luis Obispo, CA 93401-2537
Phone
(805) 543-4407
Fax
(805) 543-4587
NPI assigned
Dec 22, 2005
Last updated
Jun 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2024

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

Authorized official

Name
Michael J Ryan, MDNPI 1700863511
Title
President
Phone
(805) 543-4407

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A62340 CA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 2070377 CA Primary
Pulmonary Disease Physician 207RP1001X 2070377 CA

Addresses

Primary practice location

1428 Phillips LN
Suite 203
San Luis Obispo, CA 93401-2537

Mailing address

PO Box 12460
San Luis Obispo, CA 93406-2460
Phone (805) 548-1142

Other identifiers 6

IdentifierTypeStateIssuer
ZZZ138136ZOtherCABLUE SHIELD PIN - FRENCH
ZZZ25763ZOtherCABLUE SHIELD PIN - PHILLIP
GR0046460MedicaidCA
ZZZ13198ZOtherCABLUE SHIELD TEMPLETON
ZZZ138137ZOtherCABLUE SHIELD PIN - SVRMC
184149800OtherUS DOL PIN

Other names 1

  • Central Coast Chest Consultants Medical Corporation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040524001499 CA Part B Supplier - Clinic/Group Practice 6800877101 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
Practice locations: San Luis Obispo, CA; Templeton, CA; Santa Maria, CA

National Provider Directory

National Provider Directory

Locations

77 Casa St
Sn Luis Obisp, CA 93405
Phone (805) 269-1500

350 Posada Ln
Ste 104
Templeton, CA 93465
Phone (805) 543-4407

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 & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1740267574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12460",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934062460",
            "telephone_number": "805-548-1142",
            "fax_number": "805-234-9985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1428 PHILLIPS LN",
            "address_2": "SUITE 203",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012537",
            "telephone_number": "805-543-4407",
            "fax_number": "805-543-4587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL COAST CHEST CONSULTANTS A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-22",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-543-4407",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A62340",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "CA",
            "license": "2070377",
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "2070377",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PIN - FRENCH",
            "identifier": "ZZZ138136Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PIN - PHILLIP",
            "identifier": "ZZZ25763Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0046460",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD TEMPLETON",
            "identifier": "ZZZ13198Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PIN - SVRMC",
            "identifier": "ZZZ138137Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DOL PIN",
            "identifier": "184149800",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Coast Chest Consultants Medical Corporation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Central Coast Chest Consultants Medical Corporation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.