Pediatric Dental Initiative of the North Coast, Inc.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

550000658 Issued in CA

Legal business name

PEDIATRIC DENTAL INITIATIVE OF THE NORTH COAST, INC.

Doing business as

PDI Surgery Center

Practice address

1380 19TH Hole Dr
Windsor, CA 95492-7713

Phone

(707) 838-6560

Fax

(707) 838-8464

NPI assigned

Jun 23, 2009

Last updated

Jun 23, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Julie Belle Tucker, RN

Title

Administrator/Director of Nursing

Phone

(707) 838-6560

Specialties & licenses 1

Addresses

Other names 1

• PDI Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598993198. Details of each certification follow.

• CCN 05C0001852 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 05C0001852

Legal name

PDI SURGERY CENTER

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

May 21, 2008

Last certification

May 19, 2017

Ownership / control type

Non-Profit

Facility address

1380 19TH Hole Drive
Windsor, CA 95492

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Redwood Empire Surgery Center, Inc

  • Ambulatory Surgical Clinic/Center
  • Windsor, CA
  • NPI 1881806453
  NPPES parent name

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

{
    "created_epoch": "1245715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245715200000",
    "number": "1598993198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 19TH HOLE DR",
            "city": "WINDSOR",
            "state": "CA",
            "postal_code": "954927713",
            "telephone_number": "707-838-6560",
            "fax_number": "707-838-8464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1380 19TH HOLE DR",
            "city": "WINDSOR",
            "state": "CA",
            "postal_code": "954927713",
            "telephone_number": "707-838-6560",
            "fax_number": "707-838-8464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL INITIATIVE OF THE NORTH COAST, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-23",
        "last_updated": "2009-06-23",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "BELLE",
        "authorized_official_title_or_position": "ADMINISTRATOR/DIRECTOR OF NURSING",
        "authorized_official_telephone_number": "707-838-6560",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "550000658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PDI Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Diana Northness, LMFT
• Tysen N Norton, PA
• Mary Margaret Orosco- Dumont
• Ligaya Santos Ortega
• Priya Mohan Patel
• Shannon L Pellman
• Larissa Anne Pendergraft, LCSW
• Mark Peterson, PSY.D.
• Physiotherapy Associates Inc
• Veronica Pineda de Galli, LCSW

• Ambulatory Surgical Clinic/Center in Windsor, CA
• Providers in Windsor, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.