NPIMap

Organization Active NPI

Pathways Nursing Practitioners, Inc.

  • Rural Health Clinic/Center
  • Oakdale, CA
National Provider Identifier
1982797239
Registry record updated Aug 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
NA
Legal business name
PATHWAYS NURSING PRACTITIONERS, INC.
Doing business as
Pathway HealthCare
Practice address
190 S Oak Ave
BLDG.2-1
Oakdale, CA 95361-3528
Phone
(209) 848-8410
Fax
(209) 848-0732
NPI assigned
Oct 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2013

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

Authorized official

Name
Marc C Stoner, FNP
Title
Executive Director/Owner
Phone
(209) 848-8410

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NA Primary

Addresses

Primary practice location

190 S Oak Ave
BLDG.2-1
Oakdale, CA 95361-3528

Mailing address

190 S Oak Ave
BLDG. 2-1
Oakdale, CA 95361-3528
Phone (209) 848-8410

Other names 1

  • Pathway HealthCare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060927000185 CA Part A Provider - Rural Health Clinic 7911902853 Practice locations: Oakdale, CA

Rural health clinic certification: CCN 053971

Legal name
PATHWAYS NURSING PRACTITIONERS, INC.
Doing business as
PATHWAY HEALTHCARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 12, 1993
Last certification
Aug 29, 2017
Ownership / control type
Non-profit – corporation
Most recent change of ownership
Aug 1, 2006 (3 total)
Organization structure
CorporationProprietary
Incorporated
Mar 7, 1994 in CA
Enrollment address
190 S Oak Ave
Ste 1
Oakdale, CA 95361-3528

National Provider Directory

National Provider Directory

Locations

190 S Oak Ave
Bldg 2
Oakdale, CA 95361
Phone (209) 847-8731

190 S Oak Ave
Ste 2-1
Oakdale, CA 95361
Phone (209) 848-8410

190 S Oak Ave
Oakdale, CA 95361
Phone (209) 848-8410

190 S Oak Ave
Ste 1
Oakdale, CA 95361
Phone (209) 404-6746

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mark Stoner Individual 5% Or Greater Direct Ownership Interest Aug 1, 2006 50%
5% Or Greater Indirect Ownership InterestCeo Jan 14, 2021 50%
5% Or Greater Mortgage Interest Jan 14, 2021 50%
W-2 Managing EmployeeFamily Nurse Practitioner Aug 1, 2006
Dayna Iverson Individual 5% Or Greater Direct Ownership InterestCoo Jan 14, 2021 50%
5% Or Greater Mortgage InterestCoo Jan 14, 2021 50%
W-2 Managing EmployeeAd;BC-Family Nurse Practitioner Jan 18, 2011 50%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Dayna Iverson, FNP, RN
    • Family Nurse Practitioner
    • Oakdale, CA
    • NPI 1326588344

    5% Or Greater Direct Ownership Interest, 5% Or Greater Mortgage Interest, W-2 Managing Employee

    CMS ownership

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": "1159660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376524800000",
    "number": "1982797239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 S OAK AVE",
            "address_2": "BLDG. 2-1",
            "city": "OAKDALE",
            "state": "CA",
            "postal_code": "953613528",
            "telephone_number": "209-848-8410",
            "fax_number": "209-848-0732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 S OAK AVE",
            "address_2": "BLDG.2-1",
            "city": "OAKDALE",
            "state": "CA",
            "postal_code": "953613528",
            "telephone_number": "209-848-8410",
            "fax_number": "209-848-0732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHWAYS NURSING PRACTITIONERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-01",
        "last_updated": "2013-08-15",
        "status": "A",
        "authorized_official_last_name": "STONER",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/OWNER",
        "authorized_official_telephone_number": "209-848-8410",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": "NA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pathway HealthCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakdale, CA

Sources for this page

Verify at the official NPI Registry.