NPIMap

Organization Active NPI

Sean R Thomas MD, Inc

  • Rural Health Clinic/Center
  • Yucca Valley, CA
National Provider Identifier
1386869147
Registry record updated Feb 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
A603050 Issued in CA
Legal business name
SEAN R THOMAS MD, INC
Practice address
55585 29 Palms Hwy
Yucca Valley, CA 92284-2505
Phone
(760) 228-3366
Fax
(760) 228-3369
NPI assigned
Apr 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2015

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

Authorized official

Name
Ms. Januarie Bautista, BS
Title
Contracts Director
Phone
(760) 228-3366

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X A603050 CA Primary

Addresses

Primary practice location

55585 29 Palms Hwy
Yucca Valley, CA 92284-2505

Mailing address

55585 29 Palms Hwy
Yucca Valley, CA 92284-2505
Phone (760) 228-3366

Other identifiers 1

IdentifierTypeStateIssuer
RHM53886GMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040610001567 CA Part A Provider - Rural Health Clinic 6002899945 Practice locations: Yucca Valley, CA

Rural health clinic certification: CCN 553886

Legal name
SEAN R THOMAS MD, INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 25, 1997
Last certification
Mar 7, 2019
Ownership / control type
1B
Most recent change of ownership
Nov 1, 2001 (1 total)
Organization structure
CorporationProprietary
Incorporated
Oct 13, 2000 in CA
Enrollment address
55585 29 Palms Hwy
Yucca Valley, CA 92284-2505

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Sean R Thomas MD Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lynne Smith Individual W-2 Managing EmployeeAsst Office MGR Oct 26, 2012
Mary Callahan Individual W-2 Managing EmployeeAsst Office MGR Oct 26, 2012
Sean Thomas Individual 5% Or Greater Direct Ownership Interest Sep 15, 2001
Boun Sayasy Individual W-2 Managing EmployeeOffice Manager Oct 26, 2012
Miriam Taylor Individual W-2 Managing EmployeeContracts Director Oct 26, 2012

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

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": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424908800000",
    "number": "1386869147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55585 29 PALMS HWY",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922842505",
            "telephone_number": "760-228-3366",
            "fax_number": "760-228-3369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55585 29 PALMS HWY",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922842505",
            "telephone_number": "760-228-3366",
            "fax_number": "760-228-3369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEAN R THOMAS MD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2015-02-26",
        "status": "A",
        "authorized_official_last_name": "BAUTISTA",
        "authorized_official_first_name": "JANUARIE",
        "authorized_official_title_or_position": "CONTRACTS DIRECTOR",
        "authorized_official_telephone_number": "760-228-3366",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "A603050",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM53886G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yucca Valley, CA

Sources for this page

Verify at the official NPI Registry.