NPIMap

Organization Active NPI

Riverbank Primary Care Medical Clinic Inc.

  • Rural Health Clinic/Center
  • Riverbank, CA
National Provider Identifier
1043372618
Registry record updated Jul 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
RHM53859F Issued in CA
Legal business name
RIVERBANK PRIMARY CARE MEDICAL CLINIC INC.
Practice address
3227 Stanislaus St.
Ste 'a'
Riverbank, CA 95367
Phone
(209) 869-0131
Fax
(209) 869-5409
NPI assigned
Dec 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2022

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

Authorized official

Name
Dr. Naomi Reynolds, MD
Title
Owner
Phone
(209) 869-0131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X RHM53859F CA Primary

Addresses

Primary practice location

3227 Stanislaus St.
Ste 'a'
Riverbank, CA 95367

Mailing address

3227 Stanislaus St.
Ste 'a'
Riverbank, CA 95367
Phone (209) 869-0131

Other identifiers 1

IdentifierTypeStateIssuer
RHM53859FMedicaidCA

Other names 1

  • Riverbank Primary Care Clinic Former legal business name

Medicare participation

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

Rural health clinic certification: CCN 553859

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
RIVERBANK PRIMARY CARE MEDICAL CLINIC, INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 2, 1995
Last certification
Sep 22, 2016
Ownership / control type
1B
Facility address
3227 Stanislaus St Suite a
Riverbank, CA 95367

National Provider Directory

National Provider Directory

Locations

3227 Stanislaus St
Ste A
Riverbank, CA 95367
Phone (209) 522-1149

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1043372618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3227 STANISLAUS ST.",
            "address_2": "STE 'A'",
            "city": "RIVERBANK",
            "state": "CA",
            "postal_code": "95367",
            "telephone_number": "209-869-0131",
            "fax_number": "209-869-5409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3227 STANISLAUS ST.",
            "address_2": "STE 'A'",
            "city": "RIVERBANK",
            "state": "CA",
            "postal_code": "95367",
            "telephone_number": "209-869-0131",
            "fax_number": "209-869-5409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERBANK PRIMARY CARE MEDICAL CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "NAOMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-869-0131",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "RHM53859F",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM53859F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverbank Primary Care Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Riverbank Primary Care Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Riverbank, CA

Sources for this page

Verify at the official NPI Registry.