St Charles Spine Institute

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

Legal business name

ST CHARLES SPINE INSTITUTE

Practice address

1001 Newbury Rd
Thousand Oaks, CA 91320-6434

Phone

(805) 379-2322

Fax

(805) 379-6786

NPI assigned

Mar 22, 2016

Reactivated

Sep 6, 2023

Last updated

Oct 8, 2026By 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

Monica Fandino

Title

Billing Manager

Phone

(805) 379-2322

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• St. Charles Spine Institute

  • Physical Medicine & Rehabilitation Physician
  • Thousand Oaks, CA
  • NPI 1780377283

  O20170103001487

  Same enrollment

Practitioners 5

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.

• Bumin Kong

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Thousand Oaks, CA
  • NPI 1497382220
  NPD (past)
• Jonathan Rice, PAC

  • Surgical Physician Assistant
  • Thousand Oaks, CA
  • NPI 1720113392
  NPD (past)
• Gabriella Joy Schultz, PA-C

  • Physician Assistant
  • Thousand Oaks, CA
  • NPI 1457215964
  NPD (past)
• Lana Louie A. Wania-Galicia, MD

  • Pain Medicine (Anesthesiology) Physician
  • Moorpark, CA
  • NPI 1730166406
  NPD (past)
• Kelly Erin Olson, PA-C

  • Physician Assistant
  • Seattle, WA
  • NPI 1669027025
  NPD (past)

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791417600000",
    "number": "1912369893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 NEWBURY RD",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913206434",
            "telephone_number": "805-379-2322",
            "fax_number": "805-379-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 NEWBURY RD",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913206434",
            "telephone_number": "805-379-2322",
            "fax_number": "805-379-6786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "558 Saint Charles Dr",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Thousand Oaks",
            "state": "CA",
            "postal_code": "913603903",
            "country_code": "US",
            "telephone_number": "805-379-2322",
            "fax_number": "805-379-2373",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "415 Cochran St",
            "address_purpose": "LOCATION",
            "city": "Simi Valley",
            "state": "CA",
            "postal_code": "930656278",
            "country_code": "US",
            "telephone_number": "805-379-2322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST CHARLES SPINE INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-22",
        "last_updated": "2026-10-08",
        "certification_date": "2026-10-08",
        "deactivation_date": "2023-03-14",
        "reactivation_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "FANDINO",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "805-379-2322"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rekha Chakravarthi Srinivasan, OTR/L
• Tara Srinivasan
• SRS-Thousand Oaks (SRS-Thousand Oaks, LLC)
• St Charles Imaging Center
• St Charles Spine Institute
• St Charles Surgical Center
• Annette Dean St Marie, LMFT
• St. Charles Spine Institute
• Paige Camryn St. Clair
• Brooke Riley St. Johns

• Orthopaedic Surgery of the Spine Physician in Thousand Oaks, CA
• Providers in Thousand Oaks, CA by specialty
• Orthopaedic Surgery of the Spine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2026; 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.