NPI Code Detail JSON Logo

1245348820 NPI number — PRIMARY CARE ASSOCIATES OF THE REDWOOD EMPIRE MEDICAL GROUP, INC.

NPI Number: 1245348820
Health Care Provider/Practitioner: PRIMARY CARE ASSOCIATES OF THE REDWOOD EMPIRE MEDICAL GROUP, INC.

Information about “1245348820” NPI (PRIMARY CARE ASSOCIATES OF THE REDWOOD EMPIRE MEDICAL GROUP, INC.) exists in 1245348820 in HTML format HTML  |  1245348820 in plain Text format TXT  |  1245348820 in PDF (Portable Document Format) PDF  |  1245348820 in an XML format XML  formats.

NPI Number : 1245348820 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245348820",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PRIMARY CARE ASSOCIATES OF THE REDWOOD EMPIRE MEDICAL GROUP, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "500 DOYLE PARK DR",
    "SecondLineMailingAddress": "SUITE 200",
    "MailingAddressCityName": "SANTA ROSA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95405-4558",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "707-545-1300",
    "MailingAddressFaxNumber": "707-303-8304",
    "FirstLinePracticeLocationAddress": "500 DOYLE PARK DR",
    "SecondLinePracticeLocationAddress": "SUITE 200",
    "PracticeLocationAddressCityName": "SANTA ROSA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95405-4558",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "707-545-1300",
    "PracticeLocationAddressFaxNumber": "707-303-8304",
    "EnumerationDate": "08/25/2006",
    "LastUpdateDate": "06/21/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GREAVES",
    "AuthorizedOfficialFirstName": "LYMAN",
    "AuthorizedOfficialMiddleName": "BOWEN",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "707-545-1300",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208000000X",
          "TaxonomyName": "Pediatrics Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208M00000X",
          "TaxonomyName": "Hospitalist Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "133V00000X",
          "TaxonomyName": "Registered Dietitian",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP0200X",
          "TaxonomyName": "Pediatric Nurse Practitioner",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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