Active NPI
Institute for Health Management Inc
- Nephrology Physician
- Petaluma, CA
National Provider Identifier
1932321387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- G022984
- Legal business name
- INSTITUTE FOR HEALTH MANAGEMENT INC
- Practice address
- 715 Southpoint Blvd
Suite C
Petaluma, CA 94954-6835 - Phone
- (707) 778-6019
- Fax
- (707) 778-6068
- NPI assigned
- May 3, 2007
- Organization subpart
- No
Authorized official
NPPES NPI Registry- Name
- Dr. Robert Park, MD
- Title
- Medical Director
- Phone
- (707) 778-6019
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Endocrinology, Diabetes & Metabolism Physician
- Petaluma, CA
- NPI 1598732463
CA
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0868551 | Institute for Health Management, Inc | Certificate of waiver | Aug 31, 2026 |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050518001217 | CA | Part B Supplier - Clinic/Group Practice | 1951342021 |
Receives reassigned benefits from 1 practitioner Practice locations: Petaluma, CA |
National Provider Directory
National Provider DirectoryLocations
715 Southpoint Blvd
Ste C
Petaluma, CA 94954
Phone (707) 765-1070
Specialties & licenses 1
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | G022984 | CA | Primary |
Addresses
NPPES NPI RegistryPrimary practice location
715 Southpoint Blvd
Suite C
Petaluma, CA 94954-6835
Mailing address
715 Southpoint Blvd
Suite C
Petaluma, CA 94954-6835
Phone (707) 778-6019
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 13, 2015.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1428883200000",
"number": "1932321387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "715 SOUTHPOINT BLVD",
"address_2": "SUITE C",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949546835",
"telephone_number": "707-778-6019",
"fax_number": "707-778-6068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 SOUTHPOINT BLVD",
"address_2": "SUITE C",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949546835",
"telephone_number": "707-778-6019",
"fax_number": "707-778-6068"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INSTITUTE FOR HEALTH MANAGEMENT INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-03",
"last_updated": "2015-04-13",
"status": "A",
"authorized_official_last_name": "PARK",
"authorized_official_first_name": "ROBERT",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "707-778-6019",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Nephrology",
"state": "CA",
"license": "G022984",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.