NPIMap

Organization Active NPI

Fairchild Medical Clinic

  • Ambulatory Care Pharmacist
  • Yreka, CA
National Provider Identifier
1417542606
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Care PharmacistTaxonomy code 1835P2201X
Legal business name
FAIRCHILD MEDICAL CLINIC
Practice address
475 Bruce St
Yreka, CA 96097-3474
Phone
(530) 842-3507
NPI assigned
Mar 9, 2021
Last updated
Mar 9, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
FAIRCHILD MEDICAL CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Authorized official

Name
Paulette Adams, RN
Title
Clinic Administrator
Phone
(530) 842-3507

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Pharmacist 183500000X NU
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X NU
Non-Pharmacy Dispensing Site 332900000X NU
Ambulatory Care Pharmacist 1835P2201X NU Primary

Addresses

Primary practice location

475 Bruce St
Yreka, CA 96097-3474

Mailing address

475 Bruce St
Yreka, CA 96097-3474
Phone (530) 842-3507

Other identifiers 1

IdentifierTypeStateIssuer
1336330646MedicaidCA

National Provider Directory

National Provider Directory
Part of
Fairchild Medical Clinic

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1615248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615248000000",
    "number": "1417542606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 BRUCE ST",
            "city": "YREKA",
            "state": "CA",
            "postal_code": "960973474",
            "telephone_number": "530-842-3507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 BRUCE ST",
            "city": "YREKA",
            "state": "CA",
            "postal_code": "960973474",
            "telephone_number": "530-842-3507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRCHILD MEDICAL CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAIRCHILD MEDICAL CLINIC",
        "enumeration_date": "2021-03-09",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "PAULETTE",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "530-842-3507",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1835P2201X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Ambulatory Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336330646",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yreka, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; 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.