NPIMap

Organization Active NPI

Adventist Health Physicians Network

  • Surgery Physician
  • Clearlake, CA
National Provider Identifier
1992002083
Registry record updated Jan 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
ADVENTIST HEALTH PHYSICIANS NETWORK
Practice address
15322 Lakeshore Dr
Suite 102
Clearlake, CA 95422-9814
Phone
(707) 995-4519
NPI assigned
Feb 25, 2011
Last updated
Jan 14, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
ADVENTIST HEALTH PHYSICIANS NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 14, 2022

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

Authorized official

Name
Adrian Serna
Title
President
Phone
(916) 406-0087

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

15322 Lakeshore Dr
Suite 102
Clearlake, CA 95422-9814

Mailing address

PO Box 888794
Los Angeles, CA 90088-8794

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050407000633 CA Part B Supplier - Clinic/Group Practice 3274580972 Receives reassigned benefits from 808 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Adventist Health Physicians166 organizations share this tax ID, including this one
Part of
Adventist Health Physicians

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

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 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1298592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1992002083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 888794",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900888794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15322 LAKESHORE DR",
            "address_2": "SUITE 102",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954229814",
            "telephone_number": "707-995-4519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTIST HEALTH PHYSICIANS NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVENTIST HEALTH PHYSICIANS NETWORK",
        "enumeration_date": "2011-02-25",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A",
        "authorized_official_last_name": "SERNA",
        "authorized_official_first_name": "ADRIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-406-0087"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearlake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; 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.