Active NPI
Shane Clontz
- Community/Behavioral Health Agency
- Vacaville, CA
National Provider Identifier
1669232518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Practice address
- 942 Cedarcrest Dr
Vacaville, CA 95687-7883 - Phone
- (503) 462-5388
- NPI assigned
- Mar 19, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | CA | Primary |
Addresses
Primary practice location
942 Cedarcrest Dr
Vacaville, CA 95687-7883
Mailing address
942 Cedarcrest Dr
Vacaville, CA 95687-7883
Phone (503) 462-5388
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Convergence Life | Community/Behavioral Health | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710806400000",
"number": "1669232518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "942 CEDARCREST DR",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "956877883",
"telephone_number": "503-462-5388"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "942 CEDARCREST DR",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "956877883",
"telephone_number": "503-462-5388"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLONTZ",
"first_name": "SHANE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-19",
"last_updated": "2024-03-19",
"certification_date": "2024-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vacaville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.