NPIMap

Organization Active NPI

Central Rehabilitation Clinic Inc

  • Internal Medicine Physician
  • San Luis Obispo, CA
National Provider Identifier
1811929417
Registry record updated Oct 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G72622 Issued in CA
Legal business name
CENTRAL REHABILITATION CLINIC INC
Practice address
1334 Marsh St
San Luis Obispo, CA 93401-3316
Phone
(805) 543-2724
Fax
(805) 543-5270
NPI assigned
Jul 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2011

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

Authorized official

Name
Jeffrey M Bloom, MDNPI 1154346377
Title
President
Phone
(805) 543-2724

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X G72622 CA Primary

Addresses

Primary practice location

1334 Marsh St
San Luis Obispo, CA 93401-3316

Mailing address

1334 Marsh St
San Luis Obispo, CA 93401-3316
Phone (805) 543-2724

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ75365ZOtherCABLUE SHIELD GROUP PIN

National Provider Directory

National Provider Directory

Locations

1334 Marsh St
Sn Luis Obisp, CA 93401
Phone (805) 543-2724

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317945600000",
    "number": "1811929417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1334 MARSH ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013316",
            "telephone_number": "805-543-2724",
            "fax_number": "805-543-5270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1334 MARSH ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013316",
            "telephone_number": "805-543-2724",
            "fax_number": "805-543-5270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL REHABILITATION CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2011-10-07",
        "status": "A",
        "authorized_official_last_name": "BLOOM",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-543-2724",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G72622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP PIN",
            "identifier": "ZZZ75365Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Oct 7, 2011; 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.