Sutter Gould Medical Foundation

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SUTTER GOULD MEDICAL FOUNDATION

Doing business as

Dale Road Care Center

Practice address

3612 Dale Rd
Modesto, CA 95356-0500

Phone

(209) 524-1211

NPI assigned

May 24, 2006

Last updated

Oct 3, 2012By the provider in NPPES

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 1

Addresses

Other names 1

• Dale Road Care Center Doing business as

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349222400000",
    "number": "1326093360",
    "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": "3612 DALE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953560500",
            "telephone_number": "209-524-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER GOULD MEDICAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2012-10-03",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dale Road Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sutter Central Valley Hospitals (Memorial Medical Center)
• Sutter Central Valley Hospitals (Memorial Emergency Physicians Associates Medical Group)
• Sutter Emergency Medical Associates
• Sutter Gould Medical Foundation (Briggsmore Specialty Center)
• Sutter Gould Medical Foundation (SGMF Independent Clinical Laboratory)
• Sutter Gould Medical Foundation (Coffee Road Care Center)
• Sutter Gould Medical Foundation (Briggsmore Specialty Center Ambulatory Surgical Center)
• Sutter Gould Medical Foundation (Sylvan Eye Care Center)
• Sutter Health
• Sutter Valley Hospitals (Memorial Medical Center)

• Family Medicine Physician in Modesto, CA
• Providers in Modesto, 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 Oct 3, 2012; 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.