Individual provider Active NPI

Teresa Lynn Frankovich, MD

  • Pediatrics Physician
  • Eureka, CA
National Provider Identifier
1073609400
Registry record updated Oct 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
G66089 Issued in CA
Practice address
2200 Tydd St
Eureka, CA 95501
Phone
(707) 269-7051
Fax
(707) 269-7054
NPI assigned
Oct 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4301073637 MI
Pediatrics Physician 208000000X G66089 CA Primary

Addresses

Primary practice location

2200 Tydd St
Eureka, CA 95501

Mailing address

670 9TH St Ste 203
Arcata, CA 95521-6249
Phone (707) 826-8633

Other practice location 1

540 Depot Street
Hancock, MI 49930
Phone (906) 482-7382

Other identifiers 3

IdentifierTypeStateIssuer
4354140MedicaidMI
4301073637OtherMISTATE LICENSE
700Z745720OtherMIBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191226001163 CA Practitioner - Pediatric Medicine 9537232467 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G66089CAMDPediatrics Physician
4301073637MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Open Door Community Health Centers Current Accepting new patients
Open Door Community Health Centers Current Accepting new patients
Open Door Community Health Centers CurrentSince Oct 16, 2019 Accepting new patients
Open Door Community Health Centers Current Accepting new patients
Open Door Community Health Centers CurrentSince Oct 16, 2019 Accepting new patients
Open Door Community Health Centers Current Accepting new patients

Locations

785 18th St
Arcata, CA 95521
Phone (707) 822-2481

1275 8th St
Arcata, CA 95521

770 10th St
Arcata, CA 95521
Phone (707) 826-8610

550 E Washington Blvd
Crescent City, CA 95531
Phone (707) 465-4636

2200 Tydd St
Eureka, CA 95501
Phone (707) 269-7051

670 9th St
Ste 203
McKinleyville, CA 95521

1644 Central Ave
McKinleyville, CA 95519
Phone (707) 839-3068

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571011200000",
    "number": "1073609400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 9TH ST STE 203",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955216249",
            "telephone_number": "707-826-8633",
            "fax_number": "707-826-8638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 TYDD ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "95501",
            "telephone_number": "707-269-7051",
            "fax_number": "707-269-7054"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "540 Depot Street",
            "address_purpose": "LOCATION",
            "city": "Hancock",
            "state": "MI",
            "postal_code": "49930",
            "country_code": "US",
            "telephone_number": "906-482-7382",
            "fax_number": "906-482-9410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FRANKOVICH",
        "first_name": "TERESA",
        "middle_name": "LYNN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2019-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301073637",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G66089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4354140",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "4301073637",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "700Z745720",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eureka, CA

Sources for this page

Verify at the official NPI Registry.