Individual provider Active NPI

Diane Vickerman

  • Case Manager/Care Coordinator
  • San Andreas, CA
National Provider Identifier
1033530274
Registry record updated Dec 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
891 Mountain Ranch Rd
San Andreas, CA 95249-9713
Phone
(209) 890-7717
NPI assigned
Dec 13, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X Primary

Addresses

Primary practice location

891 Mountain Ranch Rd
San Andreas, CA 95249-9713

Mailing address

PO Box 5222
Bear Valley, CA 95223-5222
Phone (209) 890-7717

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1386892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766102400000",
    "number": "1033530274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5222",
            "city": "BEAR VALLEY",
            "state": "CA",
            "postal_code": "952235222",
            "telephone_number": "209-890-7717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "891 MOUNTAIN RANCH RD",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "952499713",
            "telephone_number": "209-890-7717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKERMAN",
        "first_name": "DIANE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-12-13",
        "last_updated": "2025-12-19",
        "certification_date": "2025-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Andreas, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.