Pacific Heart and Vascular Medical Group

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

FNP33233 Issued in CA

Legal business name

PACIFIC HEART AND VASCULAR MEDICAL GROUP

Practice address

845 S Fairmont Ave
Suite 11
Lodi, CA 95240-5113

Phone

(209) 334-0651

Fax

(209) 334-5013

NPI assigned

Jun 26, 2006

Organization subpart

No

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

Authorized official

Name

Katherine Bohna

Title

Supervisor

Phone

(209) 464-3615

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583107200000",
    "number": "1790712990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 E MARCH LN",
            "address_2": "SUITE D400",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952106629",
            "telephone_number": "209-464-3615",
            "fax_number": "209-464-1311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 S FAIRMONT AVE",
            "address_2": "SUITE 11",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405113",
            "telephone_number": "209-334-0651",
            "fax_number": "209-334-5013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC HEART AND VASCULAR MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2020-03-02",
        "certification_date": "2020-03-02",
        "status": "A",
        "authorized_official_last_name": "BOHNA",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "209-464-3615"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "FNP33233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS GRP PROVIDER #",
            "identifier": "ZZZ59847Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0086060",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP #",
            "identifier": "060057321",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Otts
• Outreach Ministries International
• Sara Kathleen Ownbey, ACSW
• P. Gill Obsteterics & Gynecology Medical Group, Inc
• P. Gill Obstetrics & Gynecology Medical Group, Inc.
• Pacific Surgical Corp.
• Brenda Jisel Palafox Rodriguez
• Brittany Nicole Palish, DPT
• Sharon Elizabeth Palmer, M.S. CCC-SLP
• Pornpit Nit Paluch, LVN

• Cardiovascular Disease Physician in Lodi, CA
• Providers in Lodi, CA by specialty
• Cardiovascular Disease Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2020; 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.