Active NPI
Redwood Community Pharmacy
- Internal Medicine Physician
- McKinleyville, CA
National Provider Identifier
1679353619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- REDWOOD COMMUNITY PHARMACY
- Practice address
- 1567 City Center Rd
McKinleyville, CA 95519-3600 - Phone
- (707) 633-4884
- NPI assigned
- Oct 5, 2023
- Organization subpart
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jennifer Anne Otting
- Title
- Owner
- Phone
- (707) 633-4884
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | Primary | ||
| Health Service Clinic/Center | 261QH0100X |
Addresses
Primary practice location
1567 City Center Rd
McKinleyville, CA 95519-3600
Mailing address
1567 City Center Rd
McKinleyville, CA 95519-3600
Phone (707) 633-4884
Other names 1
- Redwood Community Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231228001994 | CA | Part B Supplier - Clinic/Group Practice | 6709260367 | Practice locations: McKinleyville, CA |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Part of
- Redwood Community Pharmacy
Locations
1567 City Center Rd
McKinleyville, CA 95519
Phone (707) 633-3488
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1696464000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1739232000000",
"number": "1679353619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1567 CITY CENTER RD",
"city": "MCKINLEYVILLE",
"state": "CA",
"postal_code": "955193600",
"telephone_number": "707-633-4884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1567 CITY CENTER RD",
"city": "MCKINLEYVILLE",
"state": "CA",
"postal_code": "955193600",
"telephone_number": "707-633-4884"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "REDWOOD COMMUNITY PHARMACY",
"organizational_subpart": "YES",
"enumeration_date": "2023-10-05",
"last_updated": "2025-02-11",
"certification_date": "2025-02-11",
"status": "A",
"authorized_official_last_name": "OTTING",
"authorized_official_first_name": "JENNIFER",
"authorized_official_middle_name": "ANNE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "707-633-4884"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QH0100X",
"taxonomy_group": "",
"desc": "Clinic/Center, Health Service",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Redwood Community Pharmacy",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Redwood Community Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in McKinleyville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.