NPIMap

Organization Active NPI

Pacific Wound Center Medical Group, Inc.

  • Cardiovascular Disease Physician
  • Stockton, CA
National Provider Identifier
1659399202
Registry record updated Nov 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
A31110 Issued in CA
Legal business name
PACIFIC WOUND CENTER MEDICAL GROUP, INC.
Practice address
4722 Quail Lakes Dr
Suite a
Stockton, CA 95207-5256
Phone
(209) 476-0675
Fax
(209) 476-9389
NPI assigned
Jul 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2015

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

Authorized official

Name
Dr. William D. McDonald, D.P.M.NPI 1902914963
Title
Owner/Authorized Official,(Per Peco
Phone
(209) 476-0675

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X G74876 CA
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X A31110 CA Primary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X E3287 CA

Addresses

Primary practice location

4722 Quail Lakes Dr
Suite a
Stockton, CA 95207-5256

Mailing address

4722 Quail Lakes Dr
Suite a
Stockton, CA 95207-5256
Phone (209) 476-0675

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ07794ZOtherCABLUE SHIELD
ZZZ07794ZOtherBLUE SHIELD

National Provider Directory

National Provider Directory

Locations

1140 Norman Dr
Ste 103B
Manteca, CA 95336
Phone (209) 476-0675

4533 Quail Lakes Dr
Stockton, CA 95207
Phone (209) 476-0675

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448236800000",
    "number": "1659399202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4722 QUAIL LAKES DR",
            "address_2": "SUITE A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075256",
            "telephone_number": "209-476-0675",
            "fax_number": "209-476-9389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4722 QUAIL LAKES DR",
            "address_2": "SUITE A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075256",
            "telephone_number": "209-476-0675",
            "fax_number": "209-476-9389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC WOUND CENTER MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2015-11-23",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER/AUTHORIZED OFFICIAL,(PER PECO",
        "authorized_official_telephone_number": "209-476-0675",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G74876",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "A31110",
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E3287",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ07794Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ07794Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2015; 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.