HUMBOLDT MEDICAL GROUP (NPI# 1134179377) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134179377 |
| Entity Type | Organization |
| Organization Name | HUMBOLDT MEDICAL GROUP |
| Practice Address |
3306 Renner Dr Fortuna CA 95540-3120 |
| Mailing Address |
1700 Fontenay Way Roseville CA 95747-5033 |
| Practice Telephone | 7077256101 |
| Practice Fax Number | 7077252978 |
| Mailing Telephone | 9165433002 |
| Mailing Fax Number | 9162096374 |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2008-06-24 |
| Authorized Official Name | CARI ELIZABETH CANNON (ADMINISTRATOR) |
| Authorized Official Telephone | 9165433002 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 16812 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR0048520 | 05 | |
| CA | RHM053946F | 05 | |
| CA | RHM053945F | 05 |
| Street Address |
3306 RENNER DR |
| City | FORTUNA |
| State | CA |
| Zip Code | 95540-3120 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669093712 | Humboldt County Behavioral Health | Community/Behavioral Health | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2020-04-29 |
| 1316447808 | Christy Rae Bascochea | Registered Nurse | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2018-02-20 |
| 1740708874 | Nicole T. Walters | Registered Nurse | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2017-09-08 |
| 1215487947 | Pamela Jean Russ | Registered Nurse | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2016-10-05 |
| 1619360963 | Judy Gallagher | Registered Nurse | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2015-03-11 |
| 1508202821 | Margarette Jeannette Shegog | Family Medicine | 3306 Renner Dr, Fortuna, CA 95540 | 2013-05-14 |
| 1063746287 | Angela Noelle Murray | Physician Assistant | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2009-09-21 |
| 1023183969 | Maureen B Frank | Nurse Practitioner | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2006-11-22 |
| 1790735223 | Rodney Blaine Grover | Family Medicine | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2006-05-12 |
| 1891745428 | Robert G Smith | Registered Nurse | 3306 Renner Dr, Fortuna, CA 95540-3120 | 2006-05-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234787 | Remi Vista, Inc. | Community/Behavioral Health | 3000 Newburg, Fortuna, CA 95540 | 2020-01-21 |
| 1144867474 | Paula-marie Schneider | Registered Nurse | 3750 Rohnerville Rd., Fortuna, CA 95540 | 2019-12-05 |
| 1609265537 | Nancy Stinson Lollich | Physical Therapy Assistant | 2321 Newburg Road, Fortuna Rehabilitation and Wellness, Fortuna, CA 95540 | 2015-01-15 |
| 1730438151 | Heber House Inc. Dba Dermatology Center | Dermatology | 2404 Newburg Rd., Fortuna, CA 95540 | 2012-08-30 |
| 1104173418 | Michelle Leigh Hoopes | Physician Assistant | 3304 Renner Dr Suite B, Fortuna, CA 95540 | 2012-08-07 |
| 1205181526 | Constance Mitchell | Registered Nurse | Redwood Pediatrics, 3305 Renner Dr, Fortuna, CA 95540 | 2012-07-24 |
| 1730457177 | Joy Nadine Frasier | Counselor | 220 Wilson Ln., Fortuna, CA 95540 | 2011-12-13 |
| 1063791713 | Gardenside Eldercare, LLC | Residential Treatment Facility, Physical Disabilities | 529 9th Street, Fortuna, CA 95540 | 2011-08-12 |
| 1093025173 | Sheri A Jewett | Massage Therapist | 2655 Virginia Court, Fortuna, CA 95540 | 2010-10-07 |
| 1134371339 | Mariana Van Der Merwe | Pharmacist | 725 South Boulevard, Rite Aid Pharmacy, Fortuna, CA 95540 | 2008-10-21 |
| Find all providers in zip 95540 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942422688 | Stephanie S Dittmer | Family Medicine | 3750 Rohnerville Road, Fortuna, CA 95540 | 2007-05-03 |
| 1891708806 | Ruben E Brinckhaus | Family Medicine | 874 Main St, Fortuna, CA 95540-1926 | 2006-08-14 |
| 1427083187 | Clifford Ray Jones | Family Medicine | 3302 Renner Dr Ste A, Fortuna, CA 95540-7103 | 2006-07-11 |
| 1508897950 | Philip L Olkin | Family Medicine | 3302 Renner Dr, Fortuna, CA 95540-3120 | 2006-07-05 |
| 1972554301 | Donald Irving Baird | Family Medicine | 3304 Renner Dr, Fortuna, CA 95540-7102 | 2006-05-12 |
| 1871133504 | Lindsey Mendez | Family Medicine | 874 Main St, Fortuna, CA 95540-1926 | 2020-01-10 |
| 1407261001 | Jacqueline Proudfoot | Family Medicine | 3750 Rohnerville Road, Fortuna, CA 95540 | 2014-06-23 |
| 1508202821 | Margarette Jeannette Shegog | Family Medicine | 3306 Renner Dr, Fortuna, CA 95540 | 2013-05-14 |
| 1689971814 | Joni Laine Mcatee | Family Medicine | 3750 Rohnerville Road, Fortuna, CA 95540 | 2011-02-24 |
| 1952616211 | Cep America - California | Family Medicine | 3300 Renner Dr, Fortuna, CA 95540-3120 | 2010-08-11 |
| Find all providers in FORTUNA | ||||
Please comment or provide details below to improve the information on HUMBOLDT MEDICAL GROUP.
| 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.