Jack Sanford Nadler, M.D. – Family Medicine Physician

Key facts

NPI: 1164511051
Entity type: Individual (NPI type 1)
Primary specialty: Family Medicine Physician 207Q00000X
License: AO63717 (CA)
Practice address: 4300 Birch Street
Lake Isabella, CA 93240
Phone: (760) 379-1791
NPI assigned: Oct 11, 2006
Sex: Male
Sole proprietor: Yes

Organizations & group practices 3

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

Medicare reassignment NPD CA · FAMILY MEDICINE
Permanente Medical Group Inc Internal Medicine Physician · Richmond, CA · NPI 1235226531

NPD FAMILY MEDICINE
Permanente Medical Group, Inc Clinical Medical Laboratory · San Jose, CA · NPI 1497971584

NPD

Medicare participation

Medicare fee-for-service enrollment: Enrolled in CA
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20040712000715	CA	Practitioner - Family Practice	8325026776	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
AO63717	CA	MD	Family Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
Permanente Medical Group Inc	Family Medicine	Current since Feb 4, 2012	Accepting new patients
Permanente Medical Group Inc	Family Medicine	Current	Accepting new patients
Permanente Medical Group, Inc		Current since Feb 4, 2012	Accepting new patients

Locations

3900 Lakeville Hwy
Petaluma, CA 94954
Phone (707) 765-3594

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician	207Q00000X	AO63717	CA	Yes

Addresses

Primary practice location

4300 Birch Street
Lake Isabella, CA 93240

Mailing address

PO Box 91
Kernville, CA 93238-0091
Phone (760) 417-2691

Electronic endpoints

Type	Endpoint	Use	Affiliation
SOAP URL	https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq	Health Information Exchange (HIE)	The Permanente Medical Group

Other providers in Lake Isabella, CA

Sharon Kay Minds
Kelsey Marie Mixon
Samantha Ann Mongar, DO
Faith Lucille Morrison, CMT
Debra Moseley
Nicholas Anthony Nardone, DR. A.D., FACT, RAS
Kayla Nevius
Peter Jackson Newell, M.D.
Trung Nguyen, DDS
Annette Olvera Nunez, CASE MANAGER

All providers in Lake Isabella, CA · Family Medicine Physician in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.