NPIMap

Organization Active NPI

Lodi Memorial Hospital Association, Inc

Doing business as Lodi Memorial Community Clinic - Vine

  • Primary Care Clinic/Center
  • Lodi, CA
National Provider Identifier
1225285695
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
550001051 Issued in CA
Legal business name
LODI MEMORIAL HOSPITAL ASSOCIATION, INC
Doing business as
Lodi Memorial Community Clinic - Vine
Practice address
1235 W Vine St
Suite 22
Lodi, CA 95240-5109
Phone
(209) 334-8520
Fax
(209) 339-7659
NPI assigned
Aug 27, 2008
Last updated
Jan 6, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
LODI MEMORIAL HOSPITAL ASSOCIATION, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 6, 2022

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

Authorized official

Name
Jason Whitney
Title
Finance Officer
Phone
(209) 339-7477

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X CA
Primary Care Clinic/Center 261QP2300X 550001051 CA Primary

Addresses

Primary practice location

1235 W Vine St
Suite 22
Lodi, CA 95240-5109

Mailing address

PO Box 884577
Los Angeles, CA 90088-4577
Phone (209) 334-3411

Other names 1

  • Lodi Memorial Community Clinic - Vine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050517000577 CA Part B Supplier - Clinic/Group Practice 7618880717 Receives reassigned benefits from 228 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lodi, CA

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Lodi Memorial Hosptial Pharmacy West

Locations

1235 W Vine St
Ste 22
Lodi, CA 95240
Phone (209) 334-8520

NPI Registry JSON

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

{
    "created_epoch": "1219795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641427200000",
    "number": "1225285695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 884577",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900884577",
            "telephone_number": "209-334-3411",
            "fax_number": "209-339-7659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 W VINE ST",
            "address_2": "SUITE 22",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405109",
            "telephone_number": "209-334-8520",
            "fax_number": "209-339-7659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LODI MEMORIAL HOSPITAL ASSOCIATION, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LODI MEMORIAL HOSPITAL ASSOCIATION, INC",
        "enumeration_date": "2008-08-27",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A",
        "authorized_official_last_name": "WHITNEY",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "FINANCE OFFICER",
        "authorized_official_telephone_number": "209-339-7477"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "550001051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lodi Memorial Community Clinic - Vine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lodi Memorial Community Clinic - Vine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lodi, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.