1125 Sir Francis Drake Boulevard Operating Company, LLC

Primary specialty

Long Term Care HospitalTaxonomy code 282E00000X

License

110000358 Issued in CA

Legal business name

1125 SIR FRANCIS DRAKE BOULEVARD OPERATING COMPANY, LLC

Doing business as

Kentfield Rehabilitation & Specialty Hospital

Practice address

1125 Sir Francis Drake Blvd
Kentfield, CA 94904-1418

Phone

(415) 456-9680

Fax

(415) 485-3696

NPI assigned

Jun 11, 2006

Last updated

Oct 3, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tammy Jean Thompson

Title

Cfo/VP

Phone

(209) 287-6308

Specialties & licenses 1

Addresses

Other identifiers 19

Other names 1

• Kentfield Rehabilitation & Specialty Hospital Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Amplehealth

  • Internal Medicine Physician
  • Carmichael, CA
  • NPI 1508899758

  O20060801000376

  Same enrollment

Locations

Practitioners 74

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.

• Adil A Abbasi, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • La Jolla, CA
  • NPI 1548261316
  NPD
• Abulaiti Adili, M.D.

  • Hospitalist Physician
  • Modesto, CA
  • NPI 1063839439
  NPD
• Honeylynn Alcantara, NP

  • Nurse Practitioner
  • Stanford, CA
  • NPI 1780274472
  NPD
• Nazish Nawaz Ali, M.D.

  • Internal Medicine Physician
  • Antioch, CA
  • NPI 1932121498
  NPD
• Edris Aman, M.D.

  • Cardiovascular Disease Physician
  • Sacramento, CA
  • NPI 1437448511
  NPD
• Kwame Bodor-Tsia Atsina, M.D.

  • Cardiovascular Disease Physician
  • Sacramento, CA
  • NPI 1659647964
  NPD
• Khin Nyein Chan Aung, M.D

  • Internal Medicine Physician
  • Redding, CA
  • NPI 1154732154
  NPD
• Jaswinder Pal Singh Bajwa, M.D

  • Internal Medicine Physician
  • Fair Oaks, CA
  • NPI 1306000922
  NPD
• Jasdeep S Bal, M.D

  • Internal Medicine Physician
  • El Dorado Hills, CA
  • NPI 1720025802
  NPD
• Vera Batchu, MD

  • Internal Medicine Physician
  • Folsom, CA
  • NPI 1457600405
  NPD
• Sicily A Bradley, M.D.

  • Internal Medicine Physician
  • Loma Linda, CA
  • NPI 1619267366
  NPD
• Bhuvaneswari Burugapalli, M.D.

  • Internal Medicine Physician
  • Folsom, CA
  • NPI 1518127695
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696291200000",
    "number": "1760424261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 17TH ST STE 205",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953541249",
            "telephone_number": "209-287-6308",
            "fax_number": "209-248-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 SIR FRANCIS DRAKE BLVD",
            "city": "KENTFIELD",
            "state": "CA",
            "postal_code": "949041418",
            "telephone_number": "415-456-9680",
            "fax_number": "415-485-3696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1125 SIR FRANCIS DRAKE BOULEVARD OPERATING COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "CFO/VP",
        "authorized_official_telephone_number": "209-287-6308"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "CA",
            "license": "110000358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FREMONT HEALTH",
            "identifier": "05-2043",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "05-2043",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARIN IPA",
            "identifier": "05-2043",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN",
            "identifier": "05-2043",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "05-2043",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAMP AMERICA",
            "identifier": "05-2043",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET COMP 24",
            "identifier": "05-2043",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP40554I",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORVEL",
            "identifier": "05-2043",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSC00554I",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "05-2043",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "05-2043",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GENERAL REINSURANCE",
            "identifier": "05-2043",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR005541",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "05-2043",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN INDUSTRIAL MEDICINE",
            "identifier": "05-2043",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERPLAN",
            "identifier": "05-2043",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEECH STREET",
            "identifier": "05-2043",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FOUNDATION HEALTH",
            "identifier": "05-2043",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kentfield Rehabilitation & Specialty Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kentfield Rehabilitation & Specialty Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alex Barchuk M.D., Incorporated
• Sarah Alexander, MFT
• Ana Josefina Amaya, DDS MS
• Johanna Tyler Anderson, M.ED.
• Allen L Appell, PHD

• Long Term Care Hospital in Kentfield, CA
• Providers in Kentfield, CA by specialty
• Long Term Care Hospital in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; 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.