NPIMap

Organization Active NPI

Adventist Health California Medical Group, Inc.

  • Family Medicine Physician
  • Clearlake, CA
National Provider Identifier
1659668473
Registry record updated Jun 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, INC.
Practice address
15322 Lakeshore Dr
Suite 201
Clearlake, CA 95422-9814
Phone
(707) 994-2920
Fax
(707) 994-2917
NPI assigned
Jun 30, 2011
Last updated
Jun 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2011

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

Authorized official

Name
Kaye A. Donnelly
Title
Specialist, Contract Compliance
Phone
(707) 968-2809

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

15322 Lakeshore Dr
Suite 201
Clearlake, CA 95422-9814

Mailing address

1001 Adams St
Suite 102
Saint Helena, CA 94574-1107
Phone (707) 968-2809

National Provider Directory

National Provider Directory
Tax ID family
Adventist Health California Medical Group Inc35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309392000000",
    "number": "1659668473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 ADAMS ST",
            "address_2": "SUITE 102",
            "city": "SAINT HELENA",
            "state": "CA",
            "postal_code": "945741107",
            "telephone_number": "707-968-2809",
            "fax_number": "707-963-9185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15322 LAKESHORE DR",
            "address_2": "SUITE 201",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954229814",
            "telephone_number": "707-994-2920",
            "fax_number": "707-994-2917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-30",
        "last_updated": "2011-06-30",
        "status": "A",
        "authorized_official_last_name": "DONNELLY",
        "authorized_official_first_name": "KAYE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "SPECIALIST, CONTRACT COMPLIANCE",
        "authorized_official_telephone_number": "707-968-2809"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearlake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2011; 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.