NPIMap

Individual provider Active NPI

Amanthi Chandrasena, M.D.

  • Family Medicine Physician
  • Pismo Beach, CA
National Provider Identifier
1790937332
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A105736 Issued in CA
Practice address
901 Oak Park Blvd Ste 101
Pismo Beach, CA 93449
Phone
(805) 481-2205
NPI assigned
Oct 15, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A105736 CA Primary

Addresses

Primary practice location

901 Oak Park Blvd Ste 101
Pismo Beach, CA 93449

Mailing address

901 Oak Park Blvd Ste a
Pismo Beach, CA 93449-3408
Phone (805) 481-2205

Other practice location 1

877 Oak Park Blvd
Pismo Beach, CA 93449-3292
Phone (805) 474-8450

Other identifiers 1

IdentifierTypeStateIssuer
0-641-796-8OtherCAECFMG NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090128000197 CA Practitioner - Family Practice 0042374522 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Arroyo Medical Group, IncGroup PAC ID 5698723641, 5 clinicians

Practice addresses (Care Compare)

931 Oak Park Blvd
Suite 101
Pismo Beach, CA 93449-3403
Phone (805) 474-2600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions55
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A105736CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arroyo Medical Group, Inc Family Medicine CurrentSince Jan 1, 2024 Accepting new patients
First Choice Physician Partners Family Medicine Past Accepting new patients
Dignity Health Past Accepting new patients
Pacific Central Coast Health Centers Past Accepting new patients

Locations

931 Oak Park Blvd
Ste 101
Pismo Beach, CA 93449
Phone (805) 474-2600

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: amanthi.chandrasena.1@19994.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/19994/brand/1/csg/1/fhir/r4

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1224028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1790937332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 OAK PARK BLVD STE A",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493408",
            "telephone_number": "805-481-2205",
            "fax_number": "805-481-2206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 OAK PARK BLVD STE 101",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "93449",
            "telephone_number": "805-481-2205"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "877 Oak Park Blvd",
            "address_purpose": "LOCATION",
            "city": "Pismo Beach",
            "state": "CA",
            "postal_code": "934493292",
            "country_code": "US",
            "telephone_number": "805-474-8450",
            "fax_number": "805-474-8454",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHANDRASENA",
        "first_name": "AMANTHI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-15",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A105736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ECFMG NUMBER",
            "identifier": "0-641-796-8",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pismo Beach, CA

Sources for this page

Verify at the official NPI Registry.