Sutter Gould Medical Foundation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SUTTER GOULD MEDICAL FOUNDATION

Practice address

999 S Fairmont Ave
#130/135
Lodi, CA 95240-5100

Phone

(209) 366-2001

NPI assigned

May 27, 2006

Organization subpart

No

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

Authorized official

Name

Steven A Mitnick, MD

Title

Medical Director

Phone

(209) 521-6097

Specialties & licenses 2

Addresses

Other names 1

• Fairmont Ave Care Center Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273104000000",
    "number": "1174570964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554201",
            "telephone_number": "209-524-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 S FAIRMONT AVE",
            "address_2": "#130/135",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405100",
            "telephone_number": "209-366-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER GOULD MEDICAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2010-05-06",
        "status": "A",
        "authorized_official_last_name": "MITNICK",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "209-521-6097",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairmont Ave Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura Suess, RN
• Sam Nazih Suliman, D.D.S, MDS
• Marietta Abellera Sumaquial, M.D.
• Justin Jay Sunseri, LMFT
• Sutter Gould Medical Foundation
• Sutter Gould Medical Foundation
• Sutter Valley Medical Foundation
• Robert Eugene Sutter, D.D.S.,M.S.
• Diane C. Sutton, LAC
• Mitchell R Swanson, D.C.

• Internal Medicine Physician in Lodi, CA
• Providers in Lodi, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.