AGATHA JOHN (NPI# 1417329640) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417329640 |
| Entity Type | Individual |
| Full Name | AGATHA JOHN |
| Credential | NP |
| Practice Address |
324 F St Waterford CA 95386-9013 |
| Mailing Address |
215 M St Patterson CA 95363-2121 |
| Practice Telephone | 2098741292 |
| Practice Fax Number | 2098743896 |
| Mailing Telephone | 2055861983 |
| Mailing Fax Number | 2098743896 |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2019-06-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 95069913 | CA | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | A70897 | CA | Allopathic & Osteopathic Physicians |
| Y | 207R00000X | Internal Medicine | A76562 | CA | Allopathic & Osteopathic Physicians |
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
95065416 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 364SA2200X |
Clinical Nurse Specialist Specialization: Adult Health |
60579117 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 1093183261 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1108 Ward Ave Bldg A Ste 1, Patterson, CA 95363 | 2098921300 | 2097804141 |
| 2222 E Orangeburg Ave Ste A2, Modesto, CA 953553399 | 2098460321 | 2096220956 |
| Street Address |
324 F ST |
| City | WATERFORD |
| State | CA |
| Zip Code | 95386-9013 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588762538 | Krishnamoorthi Krishnamoorthi | Internal Medicine | 324 F St, Waterford, CA 95386-9013 | 2006-09-20 |
| 1316098205 | Krishnamoorthi Md Inc. | Clinic/Center | 324 F St, Waterford, CA 95386-9013 | 2007-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366857658 | Diana Hollingshead-parker | Registered Nurse | 421 Tim Bell Rd, Waterford, CA 95386 | 2014-06-25 |
| 1497817407 | James Yamamoto | Dentist | 12142 Yosemite Blvd, Waterford, CA 95386 | 2006-12-15 |
| 1588664684 | Don Michael Endress | General Practice | 12700 Welch St, Waterford, CA 95386-8765 | 2005-07-29 |
| 1649527664 | Eric Gust Benson | Registered Nurse | 12700 Welch St, Waterford, CA 95386-8765 | 2012-08-08 |
| 1326106501 | Don Michael Endress M.d. | General Practice | 12700 Welch St, Waterford, CA 95386-8765 | 2006-12-04 |
| 1356686992 | Kimberlie Ann Payne | Occupational Therapy Assistant | 13209 Fountain Dr, Waterford, CA 95386-8858 | 2012-12-08 |
| 1518423631 | Gill Pharmacy Inc | Pharmacy | 12648 Bentley St, Waterford, CA 95386-9009 | 2019-02-13 |
| 1639709520 | Ravi Gandhi | Pharmacy | 12648 Bentley St, Waterford, CA 95386-9009 | 2020-01-20 |
| 1528433588 | Livingston Community Health | Clinic/Center | 12619 Bentley St, Waterford, CA 95386-9011 | 2015-12-02 |
| 1336176122 | Maximilian A. Schanderl | Pharmacist | 12641 Bentley St, Waterford, CA 95386-9011 | 2006-06-27 |
| Find all providers in zip 95386 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124548938 | Medpal Health Clinic PC | Internal Medicine | 6743 Highland Rd Ste 5, Waterford, MI 48327-1654 | 2017-06-22 |
| 1033594106 | Atchoo Medical Practice Pllc | Internal Medicine | 4515 Highland Rd, Waterford, MI 48328-1172 | 2015-07-29 |
| 1528487246 | Stephanie Coleman | Internal Medicine | 5210 Highland Rd Ste 201, Waterford, MI 48327-1970 | 2014-04-09 |
| 1659717932 | Waterford Urgent Care PC | Internal Medicine | 5800 Highland Rd, Waterford, MI 48327-1827 | 2013-05-14 |
| 1295099372 | Candi Mcculloch | Internal Medicine | 38 Shawandassee Rd, Waterford, CT 06385-1419 | 2012-07-03 |
| 1194085076 | Meghana Rao Brito | Internal Medicine | 196 Waterford Pkwy S Ste 103, Waterford, CT 06385 | 2012-05-24 |
| 1316072531 | Paunel Grivej Md PC | Internal Medicine | 2801 Elizabeth Lake Road, Waterford, MI 48328 | 2007-02-21 |
| 1841363009 | Amita N Nair | Internal Medicine | 158 Saratoga Ave., Waterford Health Center, Waterford, NY 12188 | 2006-11-16 |
| 1265520191 | Benjamin R Newton | Internal Medicine | 230 Waterford Parkway South, Suite 201, Waterford, CT 06385 | 2006-10-10 |
| 1588762538 | Krishnamoorthi Krishnamoorthi | Internal Medicine | 324 F St, Waterford, CA 95386-9013 | 2006-09-20 |
| Find all providers in WATERFORD | ||||
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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.