Organization Active NPI

Ukiah Valley Primary Care Medical Group, Inc

  • Multi-Specialty Clinic/Center
  • Ukiah, CA
National Provider Identifier
1699759332
Registry record updated Jun 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
UKIAH VALLEY PRIMARY CARE MEDICAL GROUP, INC
Practice address
260 Hospital Dr. Ste. 207
Ukiah, CA 95482-4533
Phone
(707) 463-8000
Fax
(707) 462-1111
NPI assigned
Dec 6, 2005
Last updated
Jun 3, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2009

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

Authorized official

Name
Jeremy Mann, M.D.NPI 1831173632
Title
President, Board of Directors
Phone
(707) 463-8000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

260 Hospital Dr. Ste. 207
Ukiah, CA 95482-4533

Mailing address

PO Box 2739
Ukiah, CA 95482-2739
Phone (707) 463-8000

National Provider Directory

National Provider Directory

Locations

850 Sequoia Cir
Fort Bragg, CA 95437
Phone (707) 462-1928

487 S Main St
Ste 122
Lakeport, CA 95453
Phone (707) 263-4360

5150 Hill Rd E
Ste E
Lakeport, CA 95453
Phone (707) 263-4263

1050 N State St
Ukiah, CA 95482
Phone (707) 463-7488

1165 S Dora St
Ste A3
Ukiah, CA 95482

1165 S Dora St
Ste E1
Ukiah, CA 95482

1165 S Dora St
Ste F
Ukiah, CA 95482

1165 S Dora St
Ste G1
Ukiah, CA 95482
Phone (707) 468-0491

260 Hospital Dr
#203
Ukiah, CA 95482

620 S Dora St
Ste 204
Ukiah, CA 95482

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/fdd8a9ae-8fbb-4d2d-bbc0-da474abde02e/

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": "1133827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243987200000",
    "number": "1699759332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2739",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954822739",
            "telephone_number": "707-463-8000",
            "fax_number": "707-462-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 HOSPITAL DR. STE. 207",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824533",
            "telephone_number": "707-463-8000",
            "fax_number": "707-462-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UKIAH VALLEY PRIMARY CARE MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-06",
        "last_updated": "2009-06-03",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "PRESIDENT, BOARD OF DIRECTORS",
        "authorized_official_telephone_number": "707-463-8000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ukiah, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2009; 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.