Mobility Masters Northern California Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MOBILITY MASTERS NORTHERN CALIFORNIA INC.

Doing business as

Mobility Masters

Practice address

1575 Farmers Lane
Santa Rosa, CA 95405-7525

Phone

(707) 525-1994

Fax

(707) 525-1920

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Renate Susan Tipsword

Title

Ceo

Phone

(707) 525-1994

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Mobility Masters Doing business as

Locations

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401321600000",
    "number": "1265539217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 FARMERS LANE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954057525",
            "telephone_number": "707-525-1994",
            "fax_number": "707-525-1920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 FARMERS LANE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954057525",
            "telephone_number": "707-525-1994",
            "fax_number": "707-525-1920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILITY MASTERS NORTHERN CALIFORNIA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2014-05-29",
        "status": "A",
        "authorized_official_last_name": "TIPSWORD",
        "authorized_official_first_name": "RENATE",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "707-525-1994"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "103424",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DME03080F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "089322152002",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobility Masters",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kathryn Mitts, RN, CDE
• Kelly Miyano, RN
• Derek Michael Miyasaki, PHARMD
• Heidi Mize
• Deborah J Mizell, LCSW
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• Frank Edward Modic, M.D.
• Cindy Mogannam, MPH, RD, CSP
• Jiries Peter Mogannam, D.D.S., M.D.
• Karla Mogollan

• Durable Medical Equipment & Medical Supplies in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2014; 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.