CLEAR CREEK MEDICAL CORP (NPI# 1629583018) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1629583018 |
Entity Type | Organization |
Organization Name | CLEAR CREEK MEDICAL CORP |
Practice Address |
1100 Butte St Redding CA 96001-0852 |
Mailing Address |
738 Sunriver Ln Redding CA 96001-0166 |
Practice Telephone | 5302445400 |
Mailing Telephone | 5303552670 |
Enumeration Date | 2017-12-06 |
Last Update Date | 2018-03-17 |
Authorized Official Name | DR. GREG GREENBERG (CEO) |
Authorized Official Telephone | 5303552670 |
Authorized Official Credential | MD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
A86727 | CA | Allopathic & Osteopathic Physicians |
Address | Telephone Number | Fax Number |
---|---|---|
2801 Eureka Way, Redding, CA 960010222 | 5302469000 |
Street Address |
1100 BUTTE ST |
City | REDDING |
State | CA |
Zip Code | 96001-0852 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1073580577 | Pavan K Davuluri | Anesthesiology | 1100 Butte St, Redding, CA 96001 | 2006-03-02 |
1487255816 | Jessica Ann Kandybe | Registered Nurse | 1100 Butte St, Redding, CA 96001-0852 | 2020-11-03 |
1306474135 | Tai Chinnock Moses | Physician Assistant | 1100 Butte St, Redding, CA 96001-0852 | 2020-03-28 |
1073150025 | Carl Evan Bennett | Nurse Practitioner | 1100 Butte St, Redding, CA 96001-0852 | 2019-12-09 |
1427604636 | Maria C Morales | Nurse Practitioner | 1100 Butte St, Redding, CA 96001-0852 | 2019-08-13 |
1962982165 | Eric Lee Svendsen | Physician Assistant | 1100 Butte St, Redding, CA 96001 | 2018-08-16 |
1174017214 | Far Northern Anesthesia Consultants | Anesthesiology | 1100 Butte St, Redding, CA 96001 | 2018-06-21 |
1457879009 | Noah Chutz | Physician Assistant | 1100 Butte St, Redding, CA 96001 | 2017-09-05 |
1679007140 | Shasta Regional Emergency Medical Associates, Inc | Emergency Medicine | 1100 Butte St, Redding, CA 96001-0852 | 2017-04-12 |
1285185397 | Zachary Periharos | Physician Assistant | 1100 Butte St, Redding, CA 96001-0852 | 2016-10-24 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1730651266 | Vanessa Louise Banda | Social Worker | 1544 Magnolia Avenue, Redding, CA 96001 | 2018-12-21 |
1184194672 | Marie Sherrick | Licensed Vocational Nurse | 2030 Elreno Lane, Redding, CA 96001 | 2018-11-28 |
1699257857 | Prorehab Physical Therapy and Sports Performance, Inc | Physical Therapist | 3673 Eureka Way, Redding, CA 96001 | 2018-09-05 |
1316456833 | Jennifer Rose Goehring | Counselor | 1310 Continental Street, Redding, CA 96001 | 2017-09-27 |
1891224440 | Audrey Cutler | Social Worker | 1313 Yuba St., Redding, CA 96001 | 2017-06-07 |
1184167991 | Calafia Holdings LLC | Skilled Nursing Facility | 1836 Gold Street, Redding, CA 96001 | 2016-11-28 |
1194272369 | Shasta County | Clinic/Center | 2950 Polk Street, Rooms 2, 3, 4, Redding, CA 96001 | 2016-09-06 |
1417329236 | Shari Hayden | Specialist/Technologist, Other | 2111 Air Park Dr, Redding, CA 96001 | 2015-10-21 |
1679951982 | Shasta Hearing Aids | Health Maintenance Organization | 900 Butte St, Redding, CA 96001 | 2015-05-07 |
1073919171 | Native American Mental Health Services Corporation | Psychiatry & Neurology | 1742 Oregon Street, Redding, CA 96001 | 2014-11-17 |
Find all providers in zip 96001 |
Taxonomy Code | 207QA0401X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Family Medicine |
Specialization | Addiction Medicine |
A family medicine physician who specializes in the diagnosis and treatment of addictions. |
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1710073887 | North Valley Medical Corporation | Family Medicine | 473 South St, Redding, CA 96001-2105 | 2006-10-05 |
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1194332726 | True North Detox LLC | Family Medicine | 2413 Whitmore Ave, Clovis, CA 93619-9252 | 2020-09-28 |
1639717473 | Michael Stone Md Inc | Family Medicine | 1950 E 17th St Ste 101, Santa Ana, CA 92705-6852 | 2019-12-11 |
1720624497 | Marina Harbor Detox | Family Medicine | 289 Marina Blvd, San Francisco, CA 94123-1212 | 2019-11-18 |
1093363848 | Anthony Martin Ocana | Family Medicine | 13924 Marquesas Way Apt 1520, Marina Del Rey, CA 90292-6018 | 2019-08-26 |
1821640137 | L Snyder Incorporated | Family Medicine | 34052 La Plaza #101, Dana Point, CA 92629 | 2019-07-16 |
1720645328 | Creative Child and Family Services, Inc. | Family Medicine | 7049 Ohio River Dr, Eastvale, CA 91752 | 2019-05-20 |
1932666575 | Gold Country Health Initiative, LLC | Family Medicine | 820/830 State Highway 88, Jackson, CA 95642 | 2019-03-01 |
1629550660 | University of California Sfgh Medical Group | Family Medicine | 1001 Potrero Ave Rm 5h22, San Francisco, CA 94110-3518 | 2018-09-06 |
1952809592 | Sunrise Health & Wellness Center, LLC | Family Medicine | 10089 Folsom Blvd. Suites A & C, Rancho Cordova, CA 95670-1935 | 2018-01-29 |
1487166120 | Good Samaritan Shelter | Family Medicine | 412 East Tunnell Street, Santa Maria, CA 93454 | 2017-11-03 |
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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.