NPIMap

Organization Active NPI

Conejo Los Robles Anesthesiology Medical Group, Inc.

  • Anesthesiology Physician
  • Thousand Oaks, CA
National Provider Identifier
1821171729
Registry record updated Oct 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
CONEJO LOS ROBLES ANESTHESIOLOGY MEDICAL GROUP, INC.
Practice address
215 W Janss Rd
Thousand Oaks, CA 91360-1847
Phone
(805) 370-4521
NPI assigned
Oct 23, 2006
Last updated
Oct 2, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2007

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

Authorized official

Name
Mr. Mogens Wiese, M.D.
Title
Medical Director
Phone
(805) 370-4521

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X Primary

Addresses

Primary practice location

215 W Janss Rd
Thousand Oaks, CA 91360-1847

Mailing address

PO Box 10076
Van Nuys, CA 91410-0076
Phone (805) 578-8300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161026002332 CA Part B Supplier - Clinic/Group Practice 7517245541 Receives reassigned benefits from 52 practitioners
Practice locations: Thousand Oaks, CA

National Provider Directory

National Provider Directory

Locations

16311 Ventura Blvd
Ste 570
Encino, CA 91436
Phone (213) 245-1325

696 Hampshire Rd
Westlake Vlg, CA 91361
Phone (805) 413-7920

Practitioners & affiliated clinicians

Practitioners 54

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 54

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191283200000",
    "number": "1821171729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10076",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914100076",
            "telephone_number": "805-578-8300",
            "fax_number": "805-578-8950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 W JANSS RD",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913601847",
            "telephone_number": "805-370-4521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONEJO LOS ROBLES ANESTHESIOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2007-10-02",
        "status": "A",
        "authorized_official_last_name": "WIESE",
        "authorized_official_first_name": "MOGENS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "805-370-4521",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thousand Oaks, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2007; 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.