Pacific Heart and Vascular Medical Group

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

FNP33233 Issued in CA

Legal business name

PACIFIC HEART AND VASCULAR MEDICAL GROUP

Practice address

1801 E March Lane
Suite D400
Stockton, CA 95210-5667

Phone

(209) 464-3615

Fax

(209) 464-1311

NPI assigned

Jun 29, 2006

Organization subpart

No

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

Authorized official

Name

Katherine Bohna

Title

Supervisor

Phone

(209) 464-3615

Specialties & licenses 1

Addresses

Other identifiers 3

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583107200000",
    "number": "1649208463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 E MARCH LANE",
            "address_2": "SUITE D400",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952105667",
            "telephone_number": "209-464-3615",
            "fax_number": "209-464-1311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 E MARCH LANE",
            "address_2": "SUITE D400",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952105667",
            "telephone_number": "209-464-3615",
            "fax_number": "209-464-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC HEART AND VASCULAR MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2020-03-02",
        "certification_date": "2020-03-02",
        "status": "A",
        "authorized_official_last_name": "BOHNA",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "209-464-3615"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "FNP33233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP #",
            "identifier": "060057321",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS GROUP PROVIDER #",
            "identifier": "ZZZ59840Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0086062",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pacific Center for Addiction Services Inc.
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• Pacific Compounding Pharmacy and Consultations, Inc.
• Pacific Dermatology Medical Associates, Inc
• Pacific Kidney & Hypertension Inc
• Pacific Medical, Inc
• Pacific Medical, Inc.
• Pacific Sleep Disorders Center a California General Partnership
• Pacific Urgent Care Inc

• Cardiovascular Disease Physician in Stockton, CA
• Providers in Stockton, CA by specialty
• Cardiovascular Disease Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.