NPIMap

Adventist Health Physicians Network

Organization Active NPI Surgery Physician · Clearlake, CA

NPI 1992002083 · NPPES record last updated Jan 14, 2022

Key facts

NPI
1992002083
Entity type
Organization (NPI type 2)
Primary specialty
Surgery Physician 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
Organization subpart
Yes
Parent organization (as reported)
ADVENTIST HEALTH PHYSICIANS NETWORK

Authorized official

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

Corporate family (same tax ID) 15

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

Practitioners 2

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

  • Pari Azari, M.D. Interventional Pain Medicine Physician · Clearlake, CA · NPI 1942442132
    NPD
  • Charles Hudson, MD Psychiatry Physician · Calistoga, CA · NPI 1679549281
    NPD

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records

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

Tax ID family
Clafiornia Med FD (166 organizations share this tax ID)
Part of
Clafiornia Med FD

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD
    Plans: 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)…

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 208600000X Yes
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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 14, 2022.

{
    "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

All providers in Clearlake, CA · Surgery Physician in California

Sources for this page

Verify at the official NPI Registry.