NPIMap

Organization Active NPI

Summit Pain Alliance Inc

  • Specialist
  • Petaluma, CA
National Provider Identifier
1538559018
Registry record updated Apr 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A112702 Issued in CA
Legal business name
SUMMIT PAIN ALLIANCE INC
Practice address
157 Lynch Creek Way
Petaluma, CA 94954-2342
Phone
(707) 658-2709
Fax
(707) 981-8950
NPI assigned
Feb 4, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2018

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

Authorized official

Name
Dr. Michael Ishu Yang, MDNPI 1063665438
Title
President
Phone
(707) 658-2709

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X A112702 CA Primary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X A114663 CA

Addresses

Primary practice location

157 Lynch Creek Way
Petaluma, CA 94954-2342

Mailing address

392 Tesconi CT
Santa Rosa, CA 95401-4653
Phone (707) 623-9803

National Provider Directory

National Provider Directory

Locations

157 Lynch Creek Way
Petaluma, CA 94954
Phone (707) 658-2709

Practitioners & affiliated clinicians

Practitioners 8

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": "1423008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523923200000",
    "number": "1538559018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "392 TESCONI CT",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014653",
            "telephone_number": "707-623-9803",
            "fax_number": "707-843-3257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 LYNCH CREEK WAY",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949542342",
            "telephone_number": "707-658-2709",
            "fax_number": "707-981-8950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT PAIN ALLIANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-04",
        "last_updated": "2018-04-17",
        "status": "A",
        "authorized_official_last_name": "YANG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ISHU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-658-2709",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A112702",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A114663",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 17, 2018; 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.