NPIMap

Organization Active NPI

Galen Inpatient Physicians, PC

  • Hospitalist Physician
  • Clearlake, CA
National Provider Identifier
1801536867
Registry record updated Mar 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
GALEN INPATIENT PHYSICIANS, PC
Practice address
15630 18TH Ave
Clearlake, CA 95422-9336
Phone
(707) 994-6486
NPI assigned
Mar 29, 2022
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Theophile G. Koury, MD
Title
President/Cfo
Phone
(510) 350-2774

Corporate family (same tax ID) 18

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20040322000680 CA Part B Supplier - Clinic/Group Practice 3678464633 Receives reassigned benefits from 977 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Oxnard, CA; Redding, CA; Roseville, CA; Saint Helena, CA; San Luis Obispo, CA; Selma, CA; Simi Valley, CA; Sonora, CA…

National Provider Directory

National Provider Directory
Tax ID family
Galen Inpatient Physicians PC (53 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

15630 18TH Ave
Clearlake, CA 95422-9336

Mailing address

1601 Cummins Dr Ste D
Modesto, CA 95358-6411
Phone (510) 350-2600

Other practice location 1

700 River Dr
Fort Bragg, CA 95437-5403
Phone (707) 961-1234

Other practice location 2

275 Hospital Dr
Ukiah, CA 95482-4531
Phone (707) 462-3111

Other practice location 3

1 Marcela Dr
Willits, CA 95490-5769
Phone (707) 459-6801

Other practice location 4

10 Woodland Rd
Saint Helena, CA 94574-9554
Phone (707) 963-3611

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 29, 2022.

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648512000000",
    "number": "1801536867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 CUMMINS DR STE D",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953586411",
            "telephone_number": "510-350-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15630 18TH AVE",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954229336",
            "telephone_number": "707-994-6486"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 River Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Bragg",
            "state": "CA",
            "postal_code": "954375403",
            "country_code": "US",
            "telephone_number": "707-961-1234",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "275 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Ukiah",
            "state": "CA",
            "postal_code": "954824531",
            "country_code": "US",
            "telephone_number": "707-462-3111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Marcela Dr",
            "address_purpose": "LOCATION",
            "city": "Willits",
            "state": "CA",
            "postal_code": "954905769",
            "country_code": "US",
            "telephone_number": "707-459-6801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10 Woodland Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Helena",
            "state": "CA",
            "postal_code": "945749554",
            "country_code": "US",
            "telephone_number": "707-963-3611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GALEN INPATIENT PHYSICIANS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-29",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A",
        "authorized_official_last_name": "KOURY",
        "authorized_official_first_name": "THEOPHILE",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT/CFO",
        "authorized_official_telephone_number": "510-350-2774",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearlake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; 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.