Individual provider Active NPI

Sharon L Puita, RN ANP-C

  • Nurse Practitioner
  • San Luis Obispo, CA
National Provider Identifier
1780661512
Registry record updated Apr 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
14148 Issued in CA
Practice address
1428 Phillips LN
203
San Luis Obispo, CA 93401-2537
Phone
(805) 543-4407
Fax
(805) 543-4587
NPI assigned
Dec 22, 2005
Last updated
Apr 4, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 14148 CA Primary
Registered Nurse 163W00000X 456921 CA

Addresses

Primary practice location

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

Mailing address

1428 Phillips LN
203
San Luis Obispo, CA 93401-2537
Phone (805) 543-4407

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050808001219 CA Practitioner - Nurse Practitioner 0143259341 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Santa Maria Gastroenterology Medical Group Inc.Group PAC ID 6709070964, 23 clinicians

Practice addresses (Care Compare)

361 Town Ctr W
Santa Maria, CA 93458-5076
Phone (805) 922-6581

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.79 of 100Reported as group
Quality
74.86
Promoting interoperability
100
Improvement activities
40
Cost
73.17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
456921CAMDRegistered Nurse
14148CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hullander and Mozingo LP CurrentSince Jan 27, 2023 Accepting new patients
Hullander and Mozingo LP CurrentSince Jan 27, 2023 Accepting new patients
Doctors Medical Center of Modesto, Inc. Past Accepting new patients
Dignity Community Care Past Accepting new patients

Locations

2901 Sillect Ave
Ste 200
Bakersfield, CA 93308
Phone (661) 326-1100

222 W Pueblo St
Santa Barbara, CA 93105
Phone (626) 720-3588

222 W Pueblo St
Ste B
Santa Barbara, CA 93105

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396569600000",
    "number": "1780661512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1428 PHILLIPS LN",
            "address_2": "203",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012537",
            "telephone_number": "805-543-4407",
            "fax_number": "805-543-4587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1428 PHILLIPS LN",
            "address_2": "203",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012537",
            "telephone_number": "805-543-4407",
            "fax_number": "805-543-4587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUITA",
        "first_name": "SHARON",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "RN ANP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-22",
        "last_updated": "2014-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "14148",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "456921",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.