NPIMap

Organization Active NPI

Redwood Regional Medical Group, Inc.

  • Clinical Medical Laboratory
  • Petaluma, CA
National Provider Identifier
1487739223
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
CLF10300 Issued in CA
Legal business name
REDWOOD REGIONAL MEDICAL GROUP, INC.
Practice address
110 Lynch Creek Way Ste 110
Petaluma, CA 94954-2337
Phone
(707) 763-0600
Fax
(707) 765-1757
NPI assigned
Oct 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
David H. Schmidt, M.D.
Title
M.D./Radiologist
Phone
(707) 546-4062

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X CLF10300 CA Primary

Addresses

Primary practice location

110 Lynch Creek Way Ste 110
Petaluma, CA 94954-2337

Mailing address

110 Lynch Creek Way Ste 110
Petaluma, CA 94954-2337
Phone (707) 763-0600

Other identifiers 2

IdentifierTypeStateIssuer
GR0049200MedicaidCA
GR004920BMedicaidCA

Other names 1

  • Redwood Regional Oncology Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Redwood Regional Medica17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Locations

110 Lynch Creek Way
Ste 110
Petaluma, CA 94954
Phone (707) 763-0600

Practitioners & affiliated clinicians

Practitioners 2

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": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487739223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 LYNCH CREEK WAY STE 110",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949542337",
            "telephone_number": "707-763-0600",
            "fax_number": "707-765-1757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 LYNCH CREEK WAY STE 110",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949542337",
            "telephone_number": "707-763-0600",
            "fax_number": "707-765-1757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDWOOD REGIONAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHMIDT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "M.D./RADIOLOGIST",
        "authorized_official_telephone_number": "707-546-4062",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF10300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0049200",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR004920B",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Redwood Regional Oncology Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petaluma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.