NPIMap

Organization Active NPI

Bouch Medical Corporation

Doing business as Hill Park Medical Center

  • General Practice Physician
  • Sebastopol, CA
National Provider Identifier
1720467962
Registry record updated May 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
G35969 Issued in CA
Legal business name
BOUCH MEDICAL CORPORATION
Doing business as
Hill Park Medical Center
Practice address
435 Petaluma Ave Ste 150
Sebastopol, CA 95472-4273
Phone
(707) 861-7300
Fax
(707) 823-8568
NPI assigned
May 20, 2015
Last updated
May 20, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2015

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

Authorized official

Name
Summer Begin
Title
Practice Manager
Phone
(707) 861-7300

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 393692 CA
Neuromusculoskeletal Medicine & OMM Physician 204D00000X 20A9470 CA
Internal Medicine Physician 207R00000X G55518 CA
General Practice Physician 208D00000X ND-353 CA
General Practice Physician 208D00000X ND-613 CA
General Practice Physician 208D00000X G35969 CA Primary

Addresses

Primary practice location

435 Petaluma Ave Ste 150
Sebastopol, CA 95472-4273

Mailing address

435 Petaluma Ave Ste 150
Sebastopol, CA 95472-4273
Phone (707) 861-7300

Other names 1

  • Hill Park Medical Center Doing business as

National Provider Directory

National Provider Directory

Locations

435 Petaluma Ave
Ste 150
Sebastopol, CA 95472
Phone (707) 861-7300

Practitioners & affiliated clinicians

Practitioners 9

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": "1432080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432080000000",
    "number": "1720467962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 PETALUMA AVE STE 150",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724273",
            "telephone_number": "707-861-7300",
            "fax_number": "707-823-8568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 PETALUMA AVE STE 150",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724273",
            "telephone_number": "707-861-7300",
            "fax_number": "707-823-8568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUCH MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-20",
        "last_updated": "2015-05-20",
        "status": "A",
        "authorized_official_last_name": "BEGIN",
        "authorized_official_first_name": "SUMMER",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "707-861-7300"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "CA",
            "license": "393692",
            "primary": false
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "CA",
            "license": "20A9470",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G55518",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "ND-353",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "ND-613",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "G35969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hill Park Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sebastopol, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; 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.