NPIMap

Organization Active NPI

University of the Pacific

  • Audiologist
  • Stockton, CA
National Provider Identifier
1679766398
Registry record updated Jan 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
AU2426 Issued in CA
Legal business name
UNIVERSITY OF THE PACIFIC
Practice address
3601 Pacific Ave
Department of Audiology
Stockton, CA 95211-0110
Phone
(209) 946-2381
NPI assigned
Aug 27, 2007
Last updated
Jan 24, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2008

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

Authorized official

Name
Dr. David Alvin Jardine, AU.D.
Title
Director, Audiology Clinic
Phone
(209) 946-7490

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X AU2426 CA Primary
Audiologist-Hearing Aid Fitter 237600000X HA7228 CA

Addresses

Primary practice location

3601 Pacific Ave
Department of Audiology
Stockton, CA 95211-0110

Mailing address

3601 Pacific Ave
Department of Audiology
Stockton, CA 95211-0110
Phone (209) 946-2381

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150408002943 CA Part B Supplier - Clinic/Group Practice 2163740861 Receives reassigned benefits from 15 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stockton, CA; San Francisco, CA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
University of the Pacific29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Practitioners & affiliated clinicians

Practitioners 3

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": "1188172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201132800000",
    "number": "1679766398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 PACIFIC AVE",
            "address_2": "DEPARTMENT OF AUDIOLOGY",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952110110",
            "telephone_number": "209-946-2381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 PACIFIC AVE",
            "address_2": "DEPARTMENT OF AUDIOLOGY",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952110110",
            "telephone_number": "209-946-2381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF THE PACIFIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-27",
        "last_updated": "2008-01-24",
        "status": "A",
        "authorized_official_last_name": "JARDINE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ALVIN",
        "authorized_official_title_or_position": "DIRECTOR, AUDIOLOGY CLINIC",
        "authorized_official_telephone_number": "209-946-7490",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "AU.D."
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "CA",
            "license": "AU2426",
            "primary": true
        },
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "CA",
            "license": "HA7228",
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Jan 24, 2008; 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.

Verify at the official NPI Registry.