Active NPI
Vista del Mar Medical Group, Inc
- Nephrology Physician
- Oxnard, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- FNP4189
- Legal business name
- VISTA DEL MAR MEDICAL GROUP, INC
- Practice address
- 1200 W Gonzales Rd
Suite 300
Oxnard, CA 93036-3072 - Phone
- (805) 983-0691
- Fax
- (805) 981-1643
- NPI assigned
- Jul 2, 2006
- Last updated
- Nov 12, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Richard K Westerdoll, CAAMA, CMM
- Title
- Executive Director
- Phone
- (805) 983-0691
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | FNP4189 | CA | |
| Nephrology Physician | 207RN0300X | FNP4189 | CA | Primary |
Addresses
Primary practice location
1200 W Gonzales Rd
Suite 300
Oxnard, CA 93036-3072
Mailing address
1200 W Gonzales Rd
Suite 300
Oxnard, CA 93036-3072
Phone (805) 983-0691
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ34679Z | Other | CA | BLUE CROSS |
| ZZZ75566Z | Medicaid | CA | |
| 110039977 | Other | CA | MEDICARE RAILROAD |
Other names 1
- N/A
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
3901 Las Posas Rd
Ste 3
Camarillo, CA 93010
Phone (805) 497-9343
1200 W Gonzales Rd
Ste 100
Oxnard, CA 93036
Phone (805) 644-6673
1200 W Gonzales Rd
Ste 300
Oxnard, CA 93036
Phone (805) 278-9094
1801 Holser Walk
Ste 310
Oxnard, CA 93036
Phone (805) 988-3339
2831 Saviers Rd
Oxnard, CA 93033
Phone 4808972987111
2831 Saviers Rd
Ste B
Oxnard, CA 93033
Phone (805) 486-2929
3541 W 5th St
Oxnard, CA 93030
Phone (805) 984-5435
4567 Telephone Rd
Ste 102
Ventura, CA 93003
Phone (805) 644-6673
4567 Telephone Rd
Ste 10A
Ventura, CA 93003
Phone (805) 658-9211
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/FCFGBD
Practitioners & affiliated clinicians
Practitioners 14
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.
-
- Nephrology Physician
- Long Beach, CA
- NPI 1184063570
-
- Nephrology Physician
- Oxnard, CA
- NPI 1669561536
-
- Nurse Practitioner
- Garden Grove, CA
- NPI 1629759659
-
- Family Nurse Practitioner
- Oxnard, CA
- NPI 1508190380
-
- Nephrology Physician
- Camarillo, CA
- NPI 1073673273
-
- Nurse Practitioner
- Bakersfield, CA
- NPI 1346786647
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151798400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1636675200000",
"number": "1942239694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 W GONZALES RD",
"address_2": "SUITE 300",
"city": "OXNARD",
"state": "CA",
"postal_code": "930363072",
"telephone_number": "805-983-0691",
"fax_number": "805-981-1643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 W GONZALES RD",
"address_2": "SUITE 300",
"city": "OXNARD",
"state": "CA",
"postal_code": "930363072",
"telephone_number": "805-983-0691",
"fax_number": "805-981-1643"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VISTA DEL MAR MEDICAL GROUP, INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-02",
"last_updated": "2021-11-12",
"certification_date": "2021-11-12",
"status": "A",
"authorized_official_last_name": "WESTERDOLL",
"authorized_official_first_name": "RICHARD",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "805-983-0691",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "CAAMA, CMM"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "FNP4189",
"primary": false
},
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "CA",
"license": "FNP4189",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "ZZZ34679Z",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZZZ75566Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "110039977",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "N/A",
"code": "5",
"type": "Other Name"
},
{
"organization_name": "N/A",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Oxnard, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; 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.