Humboldt Pediatric Medical Corporation, Inc.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A64795 Issued in CA

Legal business name

HUMBOLDT PEDIATRIC MEDICAL CORPORATION, INC.

Practice address

2192 Central Ave Ste a
McKinleyville, CA 95519-3610

Phone

(707) 839-1000

Fax

(707) 839-1400

NPI assigned

Dec 5, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Sarah Bertram Poyen, MDNPI 1548234693

Title

MD

Phone

(707) 599-0642

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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

• Sarah B Poyen, M.D.

  • Pediatrics Physician
  • Stanwood, WA
  • NPI 1548234693
  NPD (past) Authorized official

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

{
    "created_epoch": "1512432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512432000000",
    "number": "1063927770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 FRESHWATER RD",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955039457",
            "telephone_number": "707-599-0642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2192 CENTRAL AVE STE A",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955193610",
            "telephone_number": "707-839-1000",
            "fax_number": "707-839-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMBOLDT PEDIATRIC MEDICAL CORPORATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-05",
        "last_updated": "2017-12-05",
        "status": "A",
        "authorized_official_last_name": "POYEN",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "BERTRAM",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "707-599-0642",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A64795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548234693",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629074570",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Hubert
• Hum Spa
• Humboldt County Behavioral Health
• Humboldt Family Medical Care
• Humboldt Medi-Trans
• Theodore Riggs Humphry, M.D.
• Babur Husain
• George Gilbert Husband, MD
• Steven Rene' Hutchinson, RPH
• Scarlet Z Ibis-Roley, IFEC-TMPH, RPF-I

• Pediatrics Physician in McKinleyville, CA
• Providers in McKinleyville, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2017; 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.