Active NPI
Stacy Pederson
- Case Manager/Care Coordinator
- Clovis, CA
National Provider Identifier
1346663796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- IMF 71954 INTERN #
- Practice address
- 20 W Bedford Ave
Clovis, CA 93611-3515 - Phone
- (559) 940-0385
- NPI assigned
- Jan 21, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | IMF 71954 INTERN # | CA | Primary |
Addresses
Primary practice location
20 W Bedford Ave
Clovis, CA 93611-3515
Mailing address
20 W Bedford Ave
Clovis, CA 93611-3515
Phone (559) 940-0385
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMF 71954 INTERN # | CA | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1390262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390262400000",
"number": "1346663796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 W BEDFORD AVE",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936113515",
"telephone_number": "559-940-0385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 W BEDFORD AVE",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936113515",
"telephone_number": "559-940-0385"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSON",
"first_name": "STACY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-01-21",
"last_updated": "2014-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "CA",
"license": "IMF 71954 INTERN #",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clovis, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 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.