DR. STEPHEN J TIDIK M.D.
NPI 1053306803
Surgery in San Luis Obispo, CA

Q: What is Stephen Tidik's NPI number?

The NPI number for Stephen Tidik is 1053306803. It was assigned to this individual provider in the NPPES registry on September 19, 2005.

Q: What is Stephen Tidik's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Q: When was this NPI record last updated?

The NPPES record for Stephen Tidik was last updated on June 17, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 19, 2005PECOS Enrolled

77 CASA ST, SUITE 103, SAN LUIS OBISPO, CA 93405(805) 544-8993(805) 544-0120 Get Directions Write a Review

NPPES record last updated: June 17, 2008. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Dr. Stephen J Tidik M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. STEPHEN J TIDIK M.D. (NPI 1053306803) is an individual surgery provider in San Luis Obispo, California, licensed in California (G57086) and active in the NPI registry since September 2005. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053306803

Entity TypeIndividualMale

Primary Taxonomy208600000X

Provider Legal NameDR. STEPHEN J TIDIKCredential: M.D.

Location Address77 CASA ST, SUITE 103San Luis Obispo, CA 93405-5803

Mailing Address77 Casa St, Suite 103San Luis Obispo, CA 93405-5803 · (805) 544-8993 · Fax (805) 544-0120

Phone(805) 544-8993

Fax(805) 544-0120

Sole ProprietorNo

Enumeration DateSeptember 19, 2005

Last NPPES UpdateJune 17, 2008

✔ NPI 1053306803 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208600000X

License✔ Licensed in CA · G57086

Definition

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Also ListedSpecialistTaxonomy 174400000X · License G57086 (CA)

77 CASA ST, San Luis Obispo, CA 93405

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Other Identifiers 5

OtherG57086CA · Medical License

Medicare PIN330002783CA

Medicaid00G570860CA

Medicare UPINB58021CA

Medicare PINWG57086CCA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Stephen J Tidik M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Stephen Tidik reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Associated Surgeons Of San Luis Obispo

11 mi

Surgery

921 OAK PARK BLVD STE 201
Pismo Beach, CA 93449

Reassigned Medicare billing, California enrollment
14 clinicians in this Medicare group

NPI 1437147485 (805) 546-0411

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 93405 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$91.64 typical visit price

range $59.84 – $178.89

Typical copayment $22.91 (range $14.96 – $44.72)

Most-billed visit code 99203

Established Patient

$74.24 typical visit price

range $19.70 – $146.55

Typical copayment $18.56 (range $4.92 – $36.63)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAUREN ELVIRA MIRABDOLLAH N.P.

Nurse Practitioner

77 CASA ST, SUITE 201-204
SAN LUIS OBISPO, CA 93405

San Luis Obispo County (805) 269-1500

FIRST CHOICE PHYSICIAN PARTNERS

Internal Medicine

77 CASA ST, SUITE 108
SAN LUIS OBISPO, CA 93405

San Luis Obispo County (805) 541-6225

DR. LESLIE G KASANOFF DC

Chiropractor

77 CASA ST, 201
SAN LUIS OBISPO, CA 93405

San Luis Obispo County (805) 269-1500

MRS. JESSICA M MALONE NP

Nurse Practitioner

77 CASA ST, SUITE 103
SAN LUIS OBISPO, CA 93405

San Luis Obispo County (805) 546-0411

ADAM JOSEPH JANETTE DDS

Dentist (Oral and Maxillofacial Surgery)

77 CASA ST, SUITE 101
SAN LUIS OBISPO, CA 93405

San Luis Obispo County (805) 541-5611

FREDERICK HASEMAN MD

Specialist

77 CASA ST, SUITE 203
SAN LUIS OBISPO, CA 93405

San Luis Obispo County (805) 544-6471

ADAM J. JANETTE, DDS INC.

Dentist (Oral and Maxillofacial Surgery)

77 CASA ST, SUITE 101
SAN LUIS OBISPO, CA 93405

San Luis Obispo County (805) 541-5611

ALICIA DUECK LCSW

Social Worker (Clinical)

77 CASA ST
SAN LUIS OBISPO, CA 93405

San Luis Obispo County (805) 269-1500

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stephen Tidik's NPI number?

The NPI number for Stephen Tidik is 1053306803. It was assigned to this individual provider in the NPPES registry on September 19, 2005.

Where is Stephen Tidik located?

Stephen Tidik practices at 77 Casa St Suite 103, San Luis Obispo, CA 93405. The listed phone number is (805) 544-8993.

What is Stephen Tidik's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Stephen Tidik enrolled in Medicare?

Yes. Stephen Tidik is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Stephen Tidik's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Stephen Tidik reassigns Medicare benefits to Associated Surgeons Of San Luis Obispo (Pismo Beach, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Stephen Tidik's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Stephen Tidik was last updated on June 17, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.