Frederick A Lodge, M.D.
Individual provider Active NPI Anesthesiology Physician · Ukiah, CA
NPI 1790770428 · NPPES record last updated Jul 30, 2010
Key facts
- NPI
- 1790770428
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 00G572072 (CA)
- Practice address
- 580 N Spring St
Ukiah, CA 95482-4251 - Phone
- (707) 468-5015
- Fax
- (707) 468-5015
- NPI assigned
- Sep 19, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Anesthesiology
- Education
- University of California, San Diego School of Medicine, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Anesthesia Management Services of California Inc
Practice addresses (Care Compare)
275 Hospital Dr
Ukiah, CA 95482-4531
Phone (707) 462-3111
Hospital & facility affiliations
- Adventist Health Ukiah Valley
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060124000384 | CA | Practitioner - Anesthesiology | 0345264859 |
Reassigns benefits to 1 organization Practice locations: Ukiah, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00G572072 | CA | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anesthesia Management Services of California Inc | Anesthesiology | Current |
Accepting new patients |
Locations
275 Hospital Dr
Ukiah, CA 95482
Phone (707) 462-7900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | G57207 | CA | |
| Anesthesiology Physician | 207L00000X | 00G572072 | CA | Yes |
Addresses
Primary practice location
580 N Spring St
Ukiah, CA 95482-4251
Mailing address
PO Box 492680
Redding, CA 96049-2680
Phone (530) 243-0440
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| YYY20507Y | Medicaid | CA |
Other providers in Ukiah, CA
- Jeremy Livingston
- Sarah A Livingston
- Dana Livneh
- Bonnie Lockhart
- Sequoia Lockhart
- Alicia J Logan
- Samuel Logan
- Victor Loi
- Andrea Road-Traveler Longoria
- Longs Drug Stores California LLC
All providers in Ukiah, CA · Anesthesiology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.