NPIMap

Organization Active NPI

Central Stockton Medical Clinic

  • Family Medicine Physician
  • Stockton, CA
National Provider Identifier
1932148343
Registry record updated Jan 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CENTRAL STOCKTON MEDICAL CLINIC
Practice address
1508 West LN
Stockton, CA 95205-3340
Phone
(209) 948-2886
Fax
(209) 948-2831
NPI assigned
Jun 5, 2006
Last updated
Jan 4, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2008

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

Authorized official

Name
Dr. Philip A Edington, MDNPI 1508837279
Title
Director/Owner
Phone
(209) 948-5515

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
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1508 West LN
Stockton, CA 95205-3340

Mailing address

1144 Norman Dr
Suite 102
Manteca, CA 95336-5925
Phone (209) 823-1152

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ25352ZOtherCAGROUP PTAN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199404800000",
    "number": "1932148343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1144 NORMAN DR",
            "address_2": "SUITE 102",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953365925",
            "telephone_number": "209-823-1152",
            "fax_number": "209-823-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 WEST LN",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952053340",
            "telephone_number": "209-948-2886",
            "fax_number": "209-948-2831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL STOCKTON MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-05",
        "last_updated": "2008-01-04",
        "status": "A",
        "authorized_official_last_name": "EDINGTON",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "209-948-5515",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "ZZZ25352Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2008; 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.