USCG AIRSTA SACRAMENTO (NPI# 1013187566) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013187566 |
| Entity Type | Organization |
| Organization Name | USCG AIRSTA SACRAMENTO |
| Practice Address |
5342 Dudley Blvd Mcclellan CA 95652-1012 |
| Mailing Address |
6037 Price Ave Mcclellan CA 95652-2400 |
| Practice Telephone | 9165617568 |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2008-03-11 |
| Authorized Official Name | MR. ROGER JOHN HARRIS (APA-C) |
| Authorized Official Telephone | 9165617568 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2865M2000X |
Military Hospital Specialization: Military General Acute Care Hospital |
Hospitals |
| Street Address |
5342 DUDLEY BLVD |
| City | MCCLELLAN |
| State | CA |
| Zip Code | 95652-1012 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235127457 | James Michael Ward | Internal Medicine | 5342 Dudley Blvd, Mcclellan Satellite Clinic, Mcclellan, CA 95652-1012 | 2005-10-11 |
| 1376182121 | Elena Lanin | Registered Nurse | 5342 Dudley Blvd, Mcclellan, CA 95652-1012 | 2019-12-26 |
| 1538702881 | Tara Ann Miskovich | Psychologist | 5342 Dudley Blvd, Mcclellan, CA 95652-1012 | 2019-10-18 |
| 1437622420 | Dominique Talley | Social Worker | 5342 Dudley Blvd, Mcclellan, CA 95652-1012 | 2019-01-02 |
| 1518489780 | Jane Grabowski | Audiologist | 5342 Dudley Blvd, Mcclellan, CA 95652-1012 | 2017-07-10 |
| 1033528963 | Valerie Christian | Nurse Practitioner | 5342 Dudley Blvd, Mcclellan, CA 95652-1012 | 2014-08-05 |
| 1760812275 | Michelle Stephens | Audiologist | 5342 Dudley Blvd, Va Mcclellan Audiology, Mcclellan, CA 95652-1012 | 2013-11-19 |
| 1780950394 | Kathryn Irene Daniels | Internal Medicine | 5342 Dudley Blvd, Mcclellan, CA 95652 | 2012-03-28 |
| 1104196930 | Mae Ruth Doctor | Nurse Practitioner | 5342 Dudley Blvd, Mcclellan, CA 95652-1012 | 2012-01-11 |
| 1225314503 | Glenda Fe Jimenez | Registered Nurse | 5342 Dudley Blvd, Mcclellan, CA 95652-1012 | 2011-10-31 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548688955 | Wenxia Han | Registered Nurse | 3401 Beech St, Bldg 949, Mcclellan, CA 95652 | 2014-04-02 |
| 1902231897 | Marisa Salas Silva | Social Worker | 3401 Beech Street, Bldg 949, Mcclellan, CA 95652 | 2013-09-10 |
| 1295070290 | Stephanie Ann Bost | Dietitian, Registered | 3401 Beech St., Mcclellan, CA 95652 | 2012-12-01 |
| 1811276025 | Brian C Choi | Dentist | 5401 Arnold Avenue, Bldg. 88, Sacramento, CA 95652 | 2011-08-05 |
| 1154408391 | California Shock Trauma Air Rescue | Ambulance | 4933 Bailey Loop, Mcclellan, CA 95652 | 2006-11-01 |
| 1083704530 | Gerald Yang | Dentist | 5401 Arnold Avenue, Sacramento, CA 95652 | 2006-10-13 |
| 1104910652 | Ann Marie Mullen | Audiologist | 5342 Dudley Blvd., Sacramento, CA 95652 | 2006-10-02 |
| 1831174556 | Mark A Duckett | Dentist | 4101 Arnold Ave, Va /mcclellan Dental Service, Scramento, CA 95652 | 2005-12-15 |
| 1073596581 | Jane P Addagatla | Internal Medicine | Va Mcclellan Opc, 5342 Dudley Blvd,bldg 98, Mcclellan Park, CA 95652 | 2005-11-29 |
| 1528518321 | Dana Kirkwood Adkins | Social Worker | 3401 Beech Street, Building 949, Room #225, Mcclellan, CA 95652 | 2016-10-05 |
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| Taxonomy Code | 2865M2000X |
| Grouping | Hospitals |
| Classification | Military Hospital |
| Specialization | Military General Acute Care Hospital |
| A Department of Defense (DoD) health care organization furnishing inpatient care 24 hours per day in "fixed" facilities, primarily for DoD beneficiaries. Entity is Defense Health Program (DHP) funded. A "fixed" facility is a non-temporary, non-deployed facility usually used for health care services. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes those services and institutional costs usually included in a Diagnosis Related Group as well as "pass-through" items. |
| Notes: [1/1/2005: title modified, definition added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649682154 | United States Navy | Military Hospital | Logistics Support Unit Onemedic, 2424 Redova Rd Bldg 156, San Diego, CA 92155-5401 | 2014-06-02 |
| 1679824585 | United States Navy | Military Hospital | Bldg 14137, Camp Pendleton, CA 92055-5697 | 2012-10-02 |
| 1396047866 | United States Navy | Military Hospital | 5065 Sunburst St, Joshua Tree, CA 92252-1831 | 2010-12-03 |
| 1316112311 | Michelle Bautista | Military Hospital | 8707 Troy St Apt 105, Spring Valley, CA 91977-2503 | 2008-04-29 |
| 1578734729 | Va San Diego Healthcare System | Military Hospital | 3350 La Jolla Village Dr -mail Box 122, San Diego, CA 92161-0002 | 2008-03-17 |
| 1760651772 | Lance Mandernack | Military Hospital | 3371 Glendale Blvd, #186, Los Angeles, CA 90039-1825 | 2008-02-22 |
| 1306919501 | Weed Army Community Hospital | Military Hospital | Inner Loop, Fort Irwin, CA 92310-5109 | 2006-11-16 |
| 1699726570 | Naval Hospital Twentynine Palms | Military Hospital | 1145 Sturgis Road, Twentynine Palms, CA 92278 | 2006-05-15 |
| 1417304445 | V.a. Long Beach Medical Center | Military Hospital | 5901 E 7th St, Long Beach, CA 90822-5201 | 2016-05-19 |
| 1023377868 | Va Hospital | Military Hospital | 2615 E Clinton Ave, Fresno, CA 93703-2223 | 2012-05-14 |
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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.