Sutter Gould Medical Foundation

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SUTTER GOULD MEDICAL FOUNDATION

Doing business as

Lodi Ave Care Center

Practice address

1300 W Lodi Ave
Ste P
Lodi, CA 95242-3000

Phone

(209) 366-1990

NPI assigned

May 26, 2006

Last updated

May 6, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Steven A Mitnick, MD

Title

Medical Director

Phone

(209) 521-6097

Specialties & licenses 2

Addresses

Other names 1

• Lodi Ave Care Center Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273104000000",
    "number": "1063468106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554201",
            "telephone_number": "209-524-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W LODI AVE",
            "address_2": "STE P",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952423000",
            "telephone_number": "209-366-1990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER GOULD MEDICAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2010-05-06",
        "status": "A",
        "authorized_official_last_name": "MITNICK",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "209-521-6097",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lodi Ave Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Janeen A Suess, LCSW
• Laura Suess, RN
• Sam Nazih Suliman, D.D.S, MDS
• Marietta Abellera Sumaquial, M.D.
• Justin Jay Sunseri, LMFT
• Sutter Gould Medical Foundation (Fairmont Ave Care Center)
• Sutter Gould Medical Foundation (Kettleman Care Center)
• Sutter Valley Medical Foundation (Sutter Gould Medical Foundation)
• Robert Eugene Sutter, D.D.S.,M.S.
• Diane C. Sutton, LAC

• Family Medicine Physician in Lodi, CA
• Providers in Lodi, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.