Individual provider Active NPI

Stephen M Manigo-Hedt, PA-C

  • Physician Assistant
  • Madera, CA
National Provider Identifier
1093792756
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
101826 Issued in NC
Practice address
201 South B Street
Camarena Health Center
Madera, CA 93638
Phone
(559) 664-4004
NPI assigned
Dec 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 101826 NC Primary

Addresses

Primary practice location

201 South B Street
Camarena Health Center
Madera, CA 93638

Mailing address

1301 1St Ave
Apt 1304
Seattle, WA 98101-2149
Phone (206) 290-0612

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)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
101826NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bestpractices of North Carolina PC Past Accepting new patients
Overlake Medical Clinics, LLC Past Accepting new patients

Organizations & group practices 2

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": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093792756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 1ST AVE",
            "address_2": "APT 1304",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981012149",
            "telephone_number": "206-290-0612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SOUTH B STREET",
            "address_2": "CAMARENA HEALTH CENTER",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "93638",
            "telephone_number": "559-664-4004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANIGO-HEDT",
        "first_name": "STEPHEN",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "101826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madera, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.