Individual provider Active NPI

Shermin Yaghoubi Rutherford, P.A.

  • Medical Physician Assistant
  • San Luis Obispo, CA
National Provider Identifier
1942646393
Registry record updated Apr 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA22866 Issued in CA
Practice address
35 Casa St Ste 370
San Luis Obispo, CA 93405-5835
Phone
(805) 541-1111
Fax
(805) 544-0834
NPI assigned
May 13, 2013
Last updated
Apr 26, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA22866 CA Primary

Addresses

Primary practice location

35 Casa St Ste 370
San Luis Obispo, CA 93405-5835

Mailing address

3599 Sueldo St
Ste 110
San Luis Obispo, CA 93401-7386
Phone (805) 786-2500

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20130903000296 CA Practitioner - Physician Assistant 6002059508 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

225 Prado Rd
Suite D
San Luis Obispo, CA 93401-7363

35 Casa St
Suite 370
San Luis Obispo, CA 93405-5835
Phone (805) 541-1111

921 Oak Park Blvd
Suite 202
Pismo Beach, CA 93449-3400
Phone (805) 473-7818

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.15 of 100Reported as group
Promoting interoperability
99
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Urology Associates of the Central Coast CurrentSince Jul 17, 2013 Accepting new patients

Locations

921 Oak Park Blvd
Ste 202
Pismo Beach, CA 93449
Phone (805) 473-7818

35 Casa St
Ste 370
San Luis Obispo, CA 93405
Phone (805) 541-1111

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/9c3d5f6c-4d59-4a7f-9170-c96c3d9e561c/

Organizations & group practices 2

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1368403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556236800000",
    "number": "1942646393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3599 SUELDO ST",
            "address_2": "STE 110",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934017386",
            "telephone_number": "805-786-2500",
            "fax_number": "805-781-0423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 CASA ST STE 370",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934055835",
            "telephone_number": "805-541-1111",
            "fax_number": "805-544-0834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTHERFORD",
        "first_name": "SHERMIN",
        "middle_name": "YAGHOUBI",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-13",
        "last_updated": "2019-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA22866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.