NPIMap

Organization Active NPI

Pediatric Resource, Inc.

  • Pediatrics Physician
  • Walnut Creek, CA
National Provider Identifier
1881810042
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC RESOURCE, INC.
Practice address
1479 Ygnacio Valley Rd
Suite 208
Walnut Creek, CA 94598-2986
Phone
(925) 634-9704
NPI assigned
Apr 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Michael Sinclair, MDNPI 1851590764
Title
President
Phone
(925) 634-9704

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1479 Ygnacio Valley Rd
Suite 208
Walnut Creek, CA 94598-2986

Mailing address

PO Box 1350
Suisun City, CA 94585-4350

Other identifiers 2

IdentifierTypeStateIssuer
GR0054191OtherCAMEDI-CAL
ZZZ39382ZOtherCABLUE SHIELD

National Provider Directory

National Provider Directory

Locations

1455 Oliver Rd
Ste 250
Fairfield, CA 94534
Phone (707) 426-5693

Practitioners & affiliated clinicians

Practitioners 6

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": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881810042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1350",
            "city": "SUISUN CITY",
            "state": "CA",
            "postal_code": "945854350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1479 YGNACIO VALLEY RD",
            "address_2": "SUITE 208",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945982986",
            "telephone_number": "925-634-9704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC RESOURCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SINCLAIR",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "925-634-9704",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "GR0054191",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ39382Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.