NPIMap

Organization Active NPI

Adventist Health Physician Network

Doing business as St. Helena Family Practice Clearlake

  • Family Medicine Physician
  • Clearlake, CA
National Provider Identifier
1023315116
Registry record updated Jun 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ADVENTIST HEALTH PHYSICIAN NETWORK
Doing business as
St. Helena Family Practice Clearlake
Practice address
15322 Lakeshore Dr
Suite 202
Clearlake, CA 95422-9814
Phone
(707) 994-0305
NPI assigned
Feb 25, 2011
Last updated
Jun 8, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
ADVENTIST HEALTH PHYSICIAN NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 8, 2011

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

Authorized official

Name
Jeff Conklin
Title
President
Phone
(916) 789-4209

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

15322 Lakeshore Dr
Suite 202
Clearlake, CA 95422-9814

Mailing address

1001 Adams St
Saint Helena, CA 94574-1107

Other names 1

  • St. Helena Family Practice Clearlake Doing business as

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
California Nedical Foun166 organizations share this tax ID, including this one
Part of
California Nedical Foun

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

Practitioners & affiliated clinicians

Practitioners 11

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": "1307491200000",
    "number": "1023315116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 ADAMS ST",
            "city": "SAINT HELENA",
            "state": "CA",
            "postal_code": "945741107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15322 LAKESHORE DR",
            "address_2": "SUITE 202",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954229814",
            "telephone_number": "707-994-0305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTIST HEALTH PHYSICIAN NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVENTIST HEALTH PHYSICIAN NETWORK",
        "enumeration_date": "2011-02-25",
        "last_updated": "2011-06-08",
        "status": "A",
        "authorized_official_last_name": "CONKLIN",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-789-4209"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Helena Family Practice Clearlake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 8, 2011; 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.