Provider Network, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PROVIDER NETWORK, INC

Practice address

1343 Newlands Dr W
Fernley, NV 89408-8926

Phone

(775) 982-5000

Fax

(775) 982-6504

NPI assigned

May 23, 2006

Organization subpart

Yes

Parent organization

HOMETOWN HEALTH MANAGEMENT COMPANYAs reported in NPPES

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

Authorized official

Name

Mr. Brett Moore

Title

Cfo Acute Care

Phone

(775) 982-6343

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fernley Medical Group Doing business as

Part of

Kimdung Nguyen MD

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Hometown Health Management Company

  • Family Medicine Physician
  • Reno, NV
  • NPI 1841761277

  Member Of

  NPD member

Locations

Practitioners 1

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

• Vivian L Graham, PA

  • Physician Assistant
  • Fallon, NV
  • NPI 1437128873
  NPD (past)

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717718400000",
    "number": "1508811084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 MILL ST # M14",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895021576",
            "telephone_number": "775-982-5262",
            "fax_number": "775-982-5496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1343 NEWLANDS DR W",
            "city": "FERNLEY",
            "state": "NV",
            "postal_code": "894088926",
            "telephone_number": "775-982-5000",
            "fax_number": "775-982-6504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDER NETWORK, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOMETOWN HEALTH MANAGEMENT COMPANY",
        "enumeration_date": "2006-05-23",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "CFO ACUTE CARE",
        "authorized_official_telephone_number": "775-982-6343",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PTAN",
            "identifier": "CG0436",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fernley Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fernley Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth A Peterson, PA
• Kristina J Petty, O.D.
• Jackie M Ponder
• Loron F Powelson, PHARMD
• Pritchett Eye Care PC
• Michael Pulhamus
• William Raymond Quarles III, PRSSS, CHW1, PCA
• Lori D Raff
• Raleys
• Pam Ramirez, RN

• Family Medicine Physician in Fernley, NV
• Providers in Fernley, NV by specialty
• Family Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; 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.