NPIMap

Organization Active NPI

Redding Primary Care Medical Group, Inc

  • Clinic/Center
  • Redding, CA
National Provider Identifier
1376669481
Registry record updated Jun 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
BUSS LIC# 23151 Issued in CA
Legal business name
REDDING PRIMARY CARE MEDICAL GROUP, INC
Practice address
1093 Hilltop Dr
Redding, CA 96003-3811
Phone
(530) 221-1565
Fax
(530) 221-3912
NPI assigned
Mar 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2021

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

Authorized official

Name
Linda Yvonne Fullerton
Title
Administrator
Phone
(530) 221-1565

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X BUSS LIC# 23151 CA Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

1093 Hilltop Dr
Redding, CA 96003-3811

Mailing address

1093 Hilltop Dr
Redding, CA 96003-3811
Phone (530) 221-1565

Other practice location 1

2123 Eureka Way
Redding, CA 96001-0428
Phone (530) 246-4629

Other identifiers 2

IdentifierTypeStateIssuer
05D1064577OtherCAMEDICARE CLIA NUMBER
ZZZ11432ZOtherCAMEDICARE PTAN

Other names 1

  • Hilltop Medical Clinic West Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040604000413 CA Part B Supplier - Clinic/Group Practice 0042292815 Receives reassigned benefits from 11 practitioners
1 other NPI on this enrollment
Practice locations: Redding, CA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

2123 Eureka Way
Redding, CA 96001
Phone (530) 243-9022

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623801600000",
    "number": "1376669481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1093 HILLTOP DR",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960033811",
            "telephone_number": "530-221-1565",
            "fax_number": "530-221-3912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1093 HILLTOP DR",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960033811",
            "telephone_number": "530-221-1565",
            "fax_number": "530-221-3912"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2123 Eureka Way",
            "address_purpose": "LOCATION",
            "city": "Redding",
            "state": "CA",
            "postal_code": "960010428",
            "country_code": "US",
            "telephone_number": "530-246-4629",
            "fax_number": "530-246-4621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REDDING PRIMARY CARE MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2021-06-16",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "FULLERTON",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "YVONNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "530-221-1565"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "BUSS LIC# 23151",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CLIA NUMBER",
            "identifier": "05D1064577",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "ZZZ11432Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hilltop Medical Clinic West",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hilltop Medical Clinic West",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Redding, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; 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.