JENNIFER A DOWALTER MD A PROFESSIONAL CORPORATION (NPI# 1811362585) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811362585 |
| Entity Type | Organization |
| Organization Name | JENNIFER A DOWALTER MD A PROFESSIONAL CORPORATION |
| Practice Address |
15630 18th Ave Clearlake CA 95422-9336 |
| Mailing Address |
Po Box 105 Mountain Center CA 92561-0105 |
| Practice Telephone | 7024533799 |
| Practice Fax Number | 7024535741 |
| Mailing Telephone | 7024533799 |
| Mailing Fax Number | 7024535741 |
| Enumeration Date | 2015-12-07 |
| Last Update Date | 2015-12-07 |
| Authorized Official Name | JENNIFER H DOWALTER (SOLE OWNER) |
| Authorized Official Telephone | 9492924082 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | A96391 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
15630 18TH AVE |
| City | CLEARLAKE |
| State | CA |
| Zip Code | 95422-9336 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124018031 | Adventist Health Clearlake Hospital Inc. | General Acute Care Hospital | 15630 18th Ave, Clearlake, CA 95422-6710 | 2005-10-24 |
| 1053927608 | Stephenie Hargrove | Nurse Practitioner | 15630 18th Ave, Clearlake, CA 95422-9336 | 2020-09-18 |
| 1740804368 | Matthew Jasun Lee | Dietitian, Registered | 15630 18th Ave, Clearlake, CA 95422-9336 | 2020-05-29 |
| 1326404948 | Bhaisaja PC | Anesthesiology | 15630 18th Ave, Clearlake, CA 95422-9336 | 2016-01-12 |
| 1609255660 | Amber Warner | Social Worker | 15630 18th Ave, Clearlake, CA 95422-9336 | 2015-05-23 |
| 1356649545 | Laurie K Halversen | Social Worker | 15630 18th Ave, Clearlake, CA 95422-9336 | 2011-03-11 |
| 1760614150 | Alliance Healthcare Services Inc | Clinic/Center | 15630 18th Ave, Clearlake, CA 95422 | 2009-08-18 |
| 1487897047 | Adventist Health Clearlake Hospital Inc. | General Acute Care Hospital | 15630 18th Ave, Clearlake, CA 95422 | 2009-04-13 |
| 1821237371 | California Em-i Medical Services | Physician Assistant | 15630 18th Ave, Clearlake, CA 95422-9336 | 2009-02-06 |
| 1023263399 | Konocti Emergency Physicians | Emergency Medicine | 15630 18th Ave, Clearlake, CA 95422-9336 | 2008-11-29 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831729201 | Richard Charles Hammond | Counselor | 7000 B South Center Drive, Clearlake, CA 95422 | 2020-01-24 |
| 1609416437 | Junirose Thom | Behavioral Analyst | 4456 Manzanita Avenue Suite 2, Clearlake, CA 95422 | 2020-01-09 |
| 1649781360 | Lake County Office of Education | Local Education Agency (LEA) | 3350 Acacia St, Clearlake, CA 95422 | 2017-10-20 |
| 1083091326 | Noelle Menesini | Physician Assistant | 15230 Lake Shore Drive, Clearlake, CA 95422 | 2015-05-06 |
| 1861820979 | Lake County Office of Education | Local Education Agency (LEA) | 6945 Old Highway 53, Clearlake, CA 95422 | 2013-10-29 |
| 1124469838 | Hassan Sheikh Moghaddas | Surgery | 15332 Lakeshore Dr Ste 101, Clearlake, CA 95422 | 2013-07-10 |
| 1366710279 | Nancy Bylund | Licensed Psychiatric Technician | 7000b South Center Drive, Clearlake, CA 95422 | 2011-12-06 |
| 1699060830 | Planned Parenthood Shasta Pacific | Clinic/Center | 1437 Olympic Drive, Cleaklake, CA 95422 | 2011-06-16 |
| 1164655247 | Hector Lara | Counselor | 14130 Lakeshore Dr., Clearlake, CA 95422 | 2009-08-24 |
| 1518197607 | Vishal V Desai | Pharmacist | 15025, Olympic Drive, Clearlake, CA 95422 | 2009-07-23 |
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| 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 |
|---|---|---|---|---|
| 1578660916 | Eric E. Kim | Internal Medicine | 4456 Manzanita Ave, Suite# C, Clearlake, CA 95422-7937 | 2006-09-20 |
| 1245212505 | Milagros Tolentino | Internal Medicine | 15666 18th Ave, Clearlake, CA 95422 | 2005-11-14 |
| 1235373184 | Marc R Shapiro Medical Corp | Internal Medicine | 3400 Emerson St, Suite A, Clearlake, CA 95422-9529 | 2009-04-22 |
| 1386659167 | Raymond Dean Jennings | Internal Medicine | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2006-07-30 |
| 1740217348 | Marc Randall Shapiro | Internal Medicine | 3400 Emerson St, Suite A, Clearlake, CA 95422-9529 | 2006-06-27 |
| 1386698363 | Catherine S Atup Leavitt | Internal Medicine | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2006-05-22 |
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|---|---|---|---|---|
| 1184225872 | Prime Medicine Partners Inc | Internal Medicine | 7647 N Fresno St, Fresno, CA 93720-2578 | 2020-11-08 |
| 1710587670 | Physicians of Southern California Inc | Internal Medicine | 1304 W Holt Blvd Ste A, Ontario, CA 91762-3640 | 2020-10-29 |
| 1538768064 | Express Carenow, Inc | Internal Medicine | 4100 Central Ave Ste 101, Riverside, CA 92506-2930 | 2020-10-26 |
| 1861091795 | Sequoia Radiation Oncology Servics, Inc | Internal Medicine | 4945 W Cypress Ave Ste A, Visalia, CA 93277-1592 | 2020-10-21 |
| 1639778673 | Deepak Mehta | Internal Medicine | C/o Medical Staff Office, Cmf, Vacaville, CA 95696 | 2020-10-21 |
| 1053919332 | Kingsley Clinic of California, PC | Internal Medicine | 275 E Hillcrest Dr Ste 160, Thousand Oaks, CA 91360-7772 | 2020-10-09 |
| 1144836826 | Dr. Stephanie Mcclellen, Md PC | Internal Medicine | 900 Hyde St Fl 4, San Francisco, CA 94109-4806 | 2020-09-18 |
| 1346856358 | Kahala Biosciences Inc | Internal Medicine | 3 Whatney Ste 200, Irvine, CA 92618-2826 | 2020-09-16 |
| 1063027050 | Vinay Panchal Md Inc | Internal Medicine | Colusa Medical Center, 199 E Webster St, Colusa, CA 95932-2954 | 2020-09-15 |
| 1962017269 | One Primary Care Inc. | Internal Medicine | 800 S Central Ave Ste 212, Glendale, CA 91204-4388 | 2020-09-14 |
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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.