NPIMap

Organization Active NPI

Coastal Radiation Oncology Medical Group, Inc.

  • Radiation Oncology Physician
  • Lompoc, CA
National Provider Identifier
1922038173
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
COASTAL RADIATION ONCOLOGY MEDICAL GROUP, INC.
Practice address
1213 E Ocean Ave Ste 100
Lompoc, CA 93436-7043
Phone
(805) 736-8628
Fax
(805) 736-8785
NPI assigned
Jul 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Authorized official

Name
Dr. Jeffrey M. Rodnick, M.D.NPI 1972595882
Title
President
Phone
(805) 648-5191

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
Radiation Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0001X Primary

Addresses

Primary practice location

1213 E Ocean Ave Ste 100
Lompoc, CA 93436-7043

Mailing address

100 Casa St
Suite C
San Luis Obispo, CA 93405-1883
Phone (805) 541-1932

Other practice location 1

100 Casa St
Suite C
San Luis Obispo, CA 93405-1883
Phone (805) 547-2252

Other practice location 2

1325 E Church St Ste 101
Santa Maria, CA 93454-5915
Phone (805) 925-2529

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060501000763 CA Part B Supplier - Clinic/Group Practice 7214946201 Receives reassigned benefits from 16 practitioners
4 other NPIs on this enrollment
Practice locations: Lompoc, CA; Ventura, CA; Thousand Oaks, CA; Templeton, CA; Santa Maria, CA; Simi Valley, CA; San Luis Obispo, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Coastal Radiation Oncology Medical Group Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1213 E Ocean Ave
Ste 100
Lompoc, CA 93436
Phone (805) 736-8628

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735171200000",
    "number": "1922038173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CASA ST",
            "address_2": "SUITE C",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934051883",
            "telephone_number": "805-541-1932",
            "fax_number": "831-684-7714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 E OCEAN AVE STE 100",
            "city": "LOMPOC",
            "state": "CA",
            "postal_code": "934367043",
            "telephone_number": "805-736-8628",
            "fax_number": "805-736-8785"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Casa St",
            "address_2": "Suite C",
            "address_purpose": "LOCATION",
            "city": "San Luis Obispo",
            "state": "CA",
            "postal_code": "934051883",
            "country_code": "US",
            "telephone_number": "805-547-2252",
            "fax_number": "805-547-2253",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1325 E Church St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Santa Maria",
            "state": "CA",
            "postal_code": "934545915",
            "country_code": "US",
            "telephone_number": "805-925-2529",
            "fax_number": "805-925-4478",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COASTAL RADIATION ONCOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A",
        "authorized_official_last_name": "RODNICK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-648-5191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lompoc, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2024; 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.