USCG ISC SAN PEDRO CLINIC (NPI# 1003968942) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003968942 |
| Entity Type | Organization |
| Organization Name | USCG ISC SAN PEDRO CLINIC |
| Practice Address |
2100 2nd St Sw Suite 5314 Washington DC 20593-0002 |
| Practice Telephone | 2022670801 |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DAVID ROMERO (CLINIC ADMINISTRATOR) |
| Authorized Official Telephone | 3107327500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
DC | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DC | 24720000X | 24720000X | 01 |
| Street Address |
2100 2ND ST SW SUITE 5314 |
| City | WASHINGTON |
| State | DC |
| Zip Code | 20593-0002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821074287 | Armando Francisco Rivera | Technician, Other | 2100 2nd St Sw, Comdt(cg-1122) Us Coast Guard, Suite 5314, Washington, DC 20593-0002 | 2005-12-19 |
| 1457599623 | Harrison Jehu Bland | Dental Hygienist | 2100 2nd St Sw, Washington, DC 20593-0002 | 2009-01-27 |
| 1659523983 | Isam Omer Awadalla Iv | Dental Hygienist | 2100 2nd St Sw, Us Coast Guard Headquarters Medical, Washington, DC 20593-0002 | 2008-10-17 |
| 1679736896 | Todd A Devore | Technician, Other | 2100 2nd St Sw, Washington, DC 20593-0002 | 2008-07-08 |
| 1336316082 | David Louis Huntley | Technician, Other | 2100 2nd St Sw, Suite 5314, Washington, DC 20593-0002 | 2008-05-13 |
| 1235303876 | Daniel G. Hernandez | Technician, Other | 2100 2nd St Sw, Suite 5314, Washington, DC 20593 | 2008-04-15 |
| 1811160757 | David James Pendzick | Technician, Health Information | 2100 2nd St Sw, Washington, DC 20593-0002 | 2008-04-11 |
| 1184897100 | Marilyn Perez | Technician, Other | 2100 2nd St Sw, Suite 5314, Washington, DC 20593-0002 | 2008-04-10 |
| 1679746697 | Uscg Clinic Borinquen | Clinic/Center | 2100 2nd St Sw, Suite 5314, Washington, DC 20593-0002 | 2008-04-10 |
| 1336327329 | Janilet Haydee Baez | Dental Assistant | 2100 2nd St Sw, Washington, DC 20593-0002 | 2008-02-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982869939 | Devon Avery | Student in an Organized Health Care Education/Training Program | 21002ndst Sw Swite 5314, Washington, DC 20593 | 2008-07-18 |
| 1922261056 | Robert Harold Spicer | Technician, Other | 2100 2nd St, Comdt (cg-1122) U.S. Coasst Guard Suite 5314, Washington, DC 20593 | 2008-07-09 |
| 1235391772 | Abby Joanna Shannon | Dentist | Uscg Base Ncr 2703 Martin Luther King Jr Ave Se, Washington, DC 20593 | 2008-06-26 |
| 1760642797 | Sweet-charity May Keplinger | Physician Assistant | 2100 2nd St Sw Suite 5, Comdt ( Cg-1122) Us Coast Guard, Washington, DC 20593 | 2008-06-12 |
| 1730346719 | Stephen M-l Tate | Student in an Organized Health Care Education/Training Program | 2100 2nd St Sw Suit, Comdt (cg-1122) Us Coast Guard, Washington, DC 20593 | 2008-05-19 |
| 1659409167 | Marc J Capra | Technician, Other | Uscg Comdt (cg-1122), 2100 2nd St Sw Suite 5314, Washington, DC 20593 | 2007-02-28 |
| 1336220730 | Christohper John Lisk | Technician, Other | 2100 2nd St Sw Suite 5314, Comdt (cg-1122) U.S. Coast Guard, Washington, DC 20593 | 2006-10-18 |
| 1013097674 | James C. Morgan | Military Health Care Provider | Comdt (cg-1122), U.S. Coast Guard 2100 2nd St Sw, Suite 5314, Washington, DC 20593 | 2006-10-17 |
| 1811077613 | Thomas Keith Heimann | Technician, Other | 2100 2nd St Sw, Suite 5314, Comdt (cg-1122), U. S. Coast Guard, Washington, DC 20593 | 2006-10-16 |
| 1447330246 | Unitied States Coast Guard | Technician, Other | 2100 2nd St Sw Comdt (cg-1122), Suite 5314 Us Coast Guard, Washington, DC 20593 | 2006-10-16 |
| Find all providers in zip 20593 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265639918 | Branch Medical Clinic Washington Navy Yard | Clinic/Center | 915 N Street Southeast, Suite 210, Washington, DC 20374-5162 | 2007-06-27 |
| 1881897544 | National Naval Medical Center | Clinic/Center | The Pentagon, Corridor 8, Washington, DC 20310-0001 | 2007-06-08 |
| 1467538371 | Uscg Headquarters Support Command (k) | Clinic/Center | Comdt 2100 2nd St Sw, Cg-1122, Suite 5314, Washington, DC 20593-0001 | 2006-10-31 |
| 1033312798 | Wramc | Clinic/Center | 6900 Georgia Ave, Usadc, Washington, DC 20310-0001 | 2007-06-08 |
| 1205042926 | Wramc | Clinic/Center | Pentagon, Washington, DC 20310-0001 | 2007-05-16 |
| 1285759712 | Uscg Ralph Nix Medical | Clinic/Center | Uscg Hq Comdt (cg-1122), 2100 Second Street South West, Washington, DC 20593-0001 | 2007-03-21 |
| 1740325380 | Uscg Air Station Barbers Point Clinic | Clinic/Center | Comdt Cg-1122, Washington, DC 20593-0001 | 2007-02-21 |
| 1326191073 | U.s Coast Guard | Clinic/Center | 2100 2nd St Sw, Suite 5314, Washington, DC 20593-0002 | 2007-01-18 |
| 1477538361 | Uscg Air Station Port Angeles Medcial/dental Clinic | Clinic/Center | Commandant Uscg Hq (cg-1122), 2100 2nd Street, Washington, DC 20593-0001 | 2005-12-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154526812 | Wramc | Clinic/Center | 103 3rd Ave Sw, Fort Mcnair, DC 20024-5120 | 2007-06-20 |
| City | WASHINGTON |
| Zip Code | 20593 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.