Active NPI
Frank Mazzone, MD
- Family Medicine Physician
- San Luis Obispo, CA
National Provider Identifier
1902939408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- A44092
- Practice address
- 47 Santa Rosa St
San Luis Obispo, CA 93405-5816 - Phone
- (805) 542-9596
- Fax
- (805) 542-0845
- NPI assigned
- Mar 13, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A44092 | CA | Primary |
Addresses
Primary practice location
47 Santa Rosa St
San Luis Obispo, CA 93405-5816
Mailing address
47 Santa Rosa St
San Luis Obispo, CA 93405-5816
Phone (805) 542-9596
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 770531398 | Other | CA | TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2018 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44092 | CA | MD | Pediatric Dentist |
| A44092 | CA | MD | Family Medicine Physician |
Interoperability endpoints
- frank.mazzone.1@13850.direct.athenahealth.com
- https://fhir4.healow.com/fhir/r4/BEACBD/Endpoint/BEACBD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465257600000",
"number": "1902939408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "47 SANTA ROSA ST",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934055816",
"telephone_number": "805-542-9596",
"fax_number": "805-542-0845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "47 SANTA ROSA ST",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934055816",
"telephone_number": "805-542-9596",
"fax_number": "805-542-0845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZZONE",
"first_name": "FRANK",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-13",
"last_updated": "2016-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A44092",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "770531398",
"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 Jun 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.