NPIMap

Organization Active NPI

Lodi Memorial Hospital Association, Inc

Doing business as Lodi Memorial Community Clinic - Iris

  • Primary Care Clinic/Center
  • Lodi, CA
National Provider Identifier
1861649352
Registry record updated Jan 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
550000838 Issued in CA
Legal business name
LODI MEMORIAL HOSPITAL ASSOCIATION, INC
Doing business as
Lodi Memorial Community Clinic - Iris
Practice address
801 S Ham Lane
Suite S
Lodi, CA 95242-7501
Phone
(209) 334-3411
Fax
(209) 339-7659
NPI assigned
Aug 26, 2008
Last updated
Jan 7, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
LODI MEMORIAL HOSPITAL ASSOCIATION, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 7, 2011

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

Authorized official

Name
Mr. Joseph P Harrington
Title
Chief Executive Officer & President
Phone
(209) 334-3411

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X CA
Primary Care Clinic/Center 261QP2300X 550000838 CA Primary

Addresses

Primary practice location

801 S Ham Lane
Suite S
Lodi, CA 95242-7501

Mailing address

PO Box 3004
Lodi, CA 95241-1908
Phone (209) 334-3411

Other names 1

  • Lodi Memorial Community Clinic - Iris Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050517000577 CA Part B Supplier - Clinic/Group Practice 7618880717 Receives reassigned benefits from 228 practitioners
9 other NPIs on this enrollment
Practice locations: Lodi, CA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Part of
Lodi Memorial Hosp Prim

Locations

1235 W Vine St
Lodi, CA 95240
Phone (209) 334-9111

1901 W Kettleman Ln
Ste 200
Lodi, CA 95242
Phone (209) 334-8540

2415 W Vine St
Ste 106
Lodi, CA 95242
Phone (209) 333-3066

845 S Fairmont Ave
Ste 8
Lodi, CA 95240
Phone (209) 339-7410

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Adventist Health Lodi MemorialGalt, CA, CCN 058546 Rural health clinic Operational/Managerial Control (100%) May 16, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 229

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.

View all 229

NPI Registry JSON

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

{
    "created_epoch": "1219708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294358400000",
    "number": "1861649352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3004",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952411908",
            "telephone_number": "209-334-3411",
            "fax_number": "209-339-7659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S HAM LANE",
            "address_2": "SUITE S",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952427501",
            "telephone_number": "209-334-3411",
            "fax_number": "209-339-7659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LODI MEMORIAL HOSPITAL ASSOCIATION, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LODI MEMORIAL HOSPITAL ASSOCIATION, INC",
        "enumeration_date": "2008-08-26",
        "last_updated": "2011-01-07",
        "status": "A",
        "authorized_official_last_name": "HARRINGTON",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER & PRESIDENT",
        "authorized_official_telephone_number": "209-334-3411",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "550000838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lodi Memorial Community Clinic - Iris",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lodi, CA

Sources for this page

Verify at the official NPI Registry.