Anna Jadwiga Hadilaksono, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95010045 Issued in CA

Practice address

128 La Colima
Pismo Beach, CA 93449-2841

Phone

(805) 608-5310

Fax

(805) 254-0128

NPI assigned

Sep 18, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

88.58 of 100Reported as group

Quality

75.84

Promoting interoperability

94

Improvement activities

40

Cost

74.41

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24466/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Restorative Spine and Pain, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Templeton, CA
  • NPI 1588234447
  Medicare reassignment NPD

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

{
    "created_epoch": "1537228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788825600000",
    "number": "1922582832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 LA COLIMA",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934492841",
            "telephone_number": "805-608-5310",
            "fax_number": "805-254-0128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 LA COLIMA",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934492841",
            "telephone_number": "805-608-5310",
            "fax_number": "805-254-0128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADILAKSONO",
        "first_name": "ANNA",
        "middle_name": "JADWIGA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-18",
        "last_updated": "2026-09-08",
        "certification_date": "2026-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95010045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Slade Arthur Goodrich, PHARMD
• Ashley Erin Gray
• Todd A Gregory, DC
• Roger Guthrie, MD
• Johannes A. Haar, M.D.
• Brian J Hanratty, D.D.S.
• Kevin Hassler, DDS
• Joanne Marie Hatcher, P.T.
• Hayashi Medical Corporation
• Edwin S. Hayashi, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Pismo Beach, CA
• Providers in Pismo Beach, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 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; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.