NPIMap

Organization Active NPI

Adventist Health California Medical Group, Inc.

  • Family Medicine Physician
  • Clearlake, CA
National Provider Identifier
1346565173
Registry record updated Apr 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G45994 Issued in CA
Legal business name
ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, INC.
Practice address
15322 Lakeshore Dr
Suite 201
Clearlake, CA 95422-9814
Phone
(707) 994-2920
Fax
(707) 994-2917
NPI assigned
Apr 5, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2010

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

Authorized official

Name
Kaye A Donnelly
Title
Credentialing Coordinator
Phone
(707) 968-2809

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X G45994 CA Primary

Addresses

Primary practice location

15322 Lakeshore Dr
Suite 201
Clearlake, CA 95422-9814

Mailing address

1572 Railroad Ave
Suite 2
Saint Helena, CA 94574-1169
Phone (707) 968-2809

Other names 1

  • St. Helena Family Practice Clearlake Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Adventist Health California Medical Group Inc35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1270425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270425600000",
    "number": "1346565173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1572 RAILROAD AVE",
            "address_2": "SUITE 2",
            "city": "SAINT HELENA",
            "state": "CA",
            "postal_code": "945741169",
            "telephone_number": "707-968-2809",
            "fax_number": "707-963-9185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15322 LAKESHORE DR",
            "address_2": "SUITE 201",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954229814",
            "telephone_number": "707-994-2920",
            "fax_number": "707-994-2917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-05",
        "last_updated": "2010-04-05",
        "status": "A",
        "authorized_official_last_name": "DONNELLY",
        "authorized_official_first_name": "KAYE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "707-968-2809"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G45994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Helena Family Practice Clearlake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clearlake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2010; 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.