Edwin Alphonse Lichwa II, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A6985 Issued in CA

Practice address

500 Jefferson Blvd Ste B180
West Sacramento, CA 95605-2394

Phone

(916) 375-6400

NPI assigned

Jul 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Specialty

General Practice

Education

University of North Texas HSC, College of Osteopathic Med, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kaiser Foundation Hospital - Vacaville Hospital, Vacaville, CA, CCN 050767

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Community Medical Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Esparto, CA
  • NPI 1588729180
  Medicare reassignment NPD
• Community Medical Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Lodi, CA
  • NPI 1891529061
  NPD
• Community Medical Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Vacaville, CA
  • NPI 1417012329
  NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510

  Family Medicine

  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Molina Healthcare of California

  • Family Medicine Physician
  • Sacramento, CA
  • NPI 1073628202
  NPD (past)
• Ole Health

  • Federally Qualified Health Center (FQHC)
  • West Sacramento, CA
  • NPI 1710087515
  NPD (past)
• Ole Health

  • Federally Qualified Health Center (FQHC)
  • West Sacramento, CA
  • NPI 1881330579
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Kaiser Foundation Hospitals

  • General Acute Care Hospital
  • Vacaville, CA
  • NPI 1710116116
  Care Compare affiliation

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1104856012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 SNAPDRAGON ST",
            "city": "WINTERS",
            "state": "CA",
            "postal_code": "956941680",
            "telephone_number": "530-795-0958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 JEFFERSON BLVD STE B180",
            "city": "WEST SACRAMENTO",
            "state": "CA",
            "postal_code": "956052394",
            "telephone_number": "916-375-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICHWA",
        "first_name": "EDWIN",
        "middle_name": "ALPHONSE",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A6985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1955 Cowell Blvd",
            "city": "Davis",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956186325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jonathan Quan Lee, DDS
• Mary Minyoung Lee, D.M.D.
• Heather Leo, DDS
• Nathaly Cecilia Leon
• Janneth Liborio-Lulo, LCSW
• Life Technologies Clinical SVCS Lab Inc.
• Lifeline E-Transport LLC
• Neal Liggins
• Tina Lilliedoll
• Yi-Chern Lin

• Family Medicine Physician in West Sacramento, CA
• Providers in West Sacramento, 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 Dec 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.