San Luis Internal Medicine Associates, a Medical Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2371545 Issued in CA

Legal business name

SAN LUIS INTERNAL MEDICINE ASSOCIATES, A MEDICAL CORPORATION

Practice address

4251 S Higuera St Ste 701
San Luis Obispo, CA 93401-7742

Phone

(805) 439-1381

Fax

(805) 439-0138

NPI assigned

Nov 21, 2005

Last updated

Oct 30, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Deborah A Cherry, MDNPI 1063495356

Title

President

Phone

(805) 439-1381

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 7

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.

• Deborah A. Cherry, M.D.

  • Internal Medicine Physician
  • San Luis Obispo, CA
  • NPI 1063495356
  Medicare reassignment Authorized official
• Allysa Rueschenberg, NP

  • Family Nurse Practitioner
  • Arroyo Grande, CA
  • NPI 1689115446
  Medicare reassignment NPD
• Jana G Hanson, MD

  • Internal Medicine Physician
  • San Luis Obispo, CA
  • NPI 1508849894
  Medicare reassignment
• Jennifer Lynn Woodward, PA-C

  • Physician Assistant
  • Templeton, CA
  • NPI 1912194689
  Medicare reassignment
• Maziar Bidar, MD

  • Ophthalmology Physician
  • Fresno, CA
  • NPI 1689693657
  NPD (past)
• Grace L Kim, M.D.

  • Anesthesiology Physician
  • San Luis Obispo, CA
  • NPI 1740276989
  NPD (past)
• Blair Monell, PA

  • Physician Assistant
  • San Luis Obispo, CA
  • NPI 1255617544
  NPD (past)

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1861475154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4251 S HIGUERA ST STE 701",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934017742",
            "telephone_number": "805-439-1381",
            "fax_number": "805-439-0138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4251 S HIGUERA ST STE 701",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934017742",
            "telephone_number": "805-439-1381",
            "fax_number": "805-439-0138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN LUIS INTERNAL MEDICINE ASSOCIATES, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-21",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "CHERRY",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-439-1381",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "2371545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA GRP#",
            "identifier": "ZZZ03051Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D0996840",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• San Luis Coastal Unified School District
• San Luis Dermatology, Inc.
• San Luis Diagnostic Medical Associates
• San Luis Hospitalists a Medical Corporation
• San Luis Imaging Medical Group, Inc
• San Luis Obispo
• San Luis Obispo Behavioral Health
• San Luis Obispo Behavioral Health
• San Luis Obispo Ca Endoscopy ASC LP (Endoscopy Center of the Central Coast)
• San Luis Obispo Campus Health

• Internal Medicine Physician in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; 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.