NPIMap

Organization Active NPI

Lodi Memorial Hospital Association Inc

  • Clinic/Center
  • Lodi, CA
National Provider Identifier
1881603009
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
030000056 Issued in CA
Legal business name
LODI MEMORIAL HOSPITAL ASSOCIATION INC
Practice address
845 S Fairmont Ave Ste 8
Lodi, CA 95240-5113
Phone
(209) 339-7625
NPI assigned
Aug 5, 2006
Organization subpart
Yes
Parent organization
LODI MEMORIAL HOSPITAL ASSOCIATION INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 6, 2022

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

Authorized official

Name
Jason Whitney
Title
Finance Officer
Phone
(209) 339-7477

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 030000056 CA Primary

Addresses

Primary practice location

845 S Fairmont Ave Ste 8
Lodi, CA 95240-5113

Mailing address

PO Box 884577
Los Angeles, CA 90088-4577
Phone (209) 334-3411

Other identifiers 2

IdentifierTypeStateIssuer
GR0086834MedicaidCA
ZZZ62129ZOtherCABS PROVIDER GRP NUMBER

Other names 1

  • Ham Lane Clinic 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
This NPI is an additional NPI on the enrollment
Practice locations: Lodi, CA

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

Locations

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

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641427200000",
    "number": "1881603009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 884577",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900884577",
            "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": "845 S FAIRMONT AVE STE 8",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405113",
            "telephone_number": "209-339-7625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LODI MEMORIAL HOSPITAL ASSOCIATION INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LODI MEMORIAL HOSPITAL ASSOCIATION INC",
        "enumeration_date": "2006-08-05",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A",
        "authorized_official_last_name": "WHITNEY",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "FINANCE OFFICER",
        "authorized_official_telephone_number": "209-339-7477"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "030000056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0086834",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS PROVIDER GRP NUMBER",
            "identifier": "ZZZ62129Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ham Lane Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ham Lane Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lodi, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 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.