Individual provider Active NPI

Jane Diane McClenahan, M.D.

  • Internal Medicine Physician
  • Atascadero, CA
National Provider Identifier
1679599377
Registry record updated May 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G57808 Issued in CA
Practice address
10333 El Camino Real
Atascadero, CA 93422-5808
Phone
(805) 468-2188
NPI assigned
Jul 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Internal Medicine) Physician 207RA0401X G57808 CA
Internal Medicine Physician 207R00000X G57808 CA Primary

Addresses

Primary practice location

10333 El Camino Real
Atascadero, CA 93422-5808

Mailing address

10333 El Camino Real
Atascadero, CA 93422-5808

Other identifiers 2

IdentifierTypeStateIssuer
00G578080MedicaidCA
G57808OtherCAMED LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050718001027 CA Practitioner - Internal Medicine 2567499924 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
57808CAMDPeriodontist
G57808CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Department of State Hospitals CurrentSince Apr 29, 2019 Accepting new patients
Department of State Hospitals Current Accepting new patients

Locations

10333 El Camino Real
Atascadero, CA 93422
Phone (805) 468-2000

1600 9th St
Ste 150
Sacramento, CA 95814
Phone (916) 651-8811

1215 O St
#3
Sacramento, CA 95814
Phone (916) 651-2805

Organizations & group practices 2

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": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556841600000",
    "number": "1679599377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10333 EL CAMINO REAL",
            "city": "ATASCADERO",
            "state": "CA",
            "postal_code": "934225808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10333 EL CAMINO REAL",
            "city": "ATASCADERO",
            "state": "CA",
            "postal_code": "934225808",
            "telephone_number": "805-468-2188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLENAHAN",
        "first_name": "JANE",
        "middle_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2019-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "CA",
            "license": "G57808",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G57808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G578080",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MED LICENSE",
            "identifier": "G57808",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atascadero, CA

Sources for this page

Verify at the official NPI Registry.