95TH MEDICAL GROUP SGSR (NPI# 1891765046) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891765046 |
| Entity Type | Organization |
| Organization Name | 95TH MEDICAL GROUP SGSR |
| Practice Address |
30 Nightingale Rd Bldg 5525 Edwards Afb CA 93524-0001 |
| Practice Telephone | 6612752634 |
| Practice Fax Number | 6612776645 |
| Mailing Telephone | 6612752634 |
| Mailing Fax Number | 6612776645 |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2014-03-10 |
| Authorized Official Name | THERESA MARIE MITCHELL (AIR FORCE UBO ANALYST) |
| Authorized Official Telephone | 7036817613 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM1101X |
Clinic/Center Specialization: Military and U.S. Coast Guard Ambulatory Procedure |
Ambulatory Health Care Facilities | ||
| N | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers | ||
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | NCPDP | 05-40345 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982703930 | 95th Medical Group Sgsr | Military/U.S. Coast Guard Pharmacy | 30 Nightingale, Bldg 5525, Edwards Afb, CA 93524-0001 | 2006-09-22 |
| 1548673163 | 95th Medical Group Sgsr | Military/U.S. Coast Guard Pharmacy | 30 Nightingale Rd, Bldg 5525, Edwards Afb, CA 93524-1730 | 2014-06-11 |
| Street Address |
30 NIGHTINGALE RD BLDG 5525 |
| City | EDWARDS AFB |
| State | CA |
| Zip Code | 93524-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306827050 | Matthew Richard Keysor | Pediatrics | 30 Nightingale Rd, Attn: 412 Mdg/sgh, Edwards Afb, CA 93524-1730 | 2005-11-09 |
| 1356791495 | Aaron Patzwahl | Family Medicine | 30 Nightingale Rd, Edwards Afb, CA 93524-1809 | 2016-06-20 |
| 1992150569 | Nicholas Charles Kern | Military Health Care Provider | 30 Nightingale Rd, Edwards Afb, CA 93524-0001 | 2016-05-02 |
| 1073980181 | Anne H Kim | Specialist | 30 Nightingale Rd, Bldg 5521, Edwards Afb, CA 93524-0001 | 2015-08-24 |
| 1548673163 | 95th Medical Group Sgsr | Military/U.S. Coast Guard Pharmacy | 30 Nightingale Rd, Bldg 5525, Edwards Afb, CA 93524-1730 | 2014-06-11 |
| 1538585872 | Josephine Nguyen | Dentist | 30 Nightingale Rd, Edwards Afb, CA 93524-1730 | 2014-03-11 |
| 1184062101 | Piotr Wojciech Podlesny | Family Medicine | 30 Nightingale Rd, 412mdos/sgop Family Health Clinic, Edwards Afb, CA 93524-0001 | 2013-06-12 |
| 1437493806 | Scott Anthony Baker | Pharmacist | 30 Nightingale Rd, Edwards Afb, CA 93524-0001 | 2012-11-25 |
| 1780958645 | Shunrie Geldore | Physician Assistant | 30 Nightingale Rd, Edwards Afb, CA 93524-0001 | 2012-02-23 |
| 1790018299 | Christopher John Raimondi | Dentist | 30 Nightingale Rd, Edwards Afb, CA 93524-0001 | 2009-09-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114540499 | Nathaniel George Brown | Student in an Organized Health Care Education/Training Program | 412th Medical Group 30 Nightingale Rd., Building #5525, Edwards Air Force Base, CA 93524 | 2020-05-21 |
| 1265852396 | Wesley John Fischer | Pharmacist | 30 Nightengale Road, Edwards U.S. Air Force Base Pharmacy, Edwards, CA 93524 | 2014-04-16 |
| 1659567493 | Kevin Ray Hooker | Social Worker | 30 Nightingale Road, 5513, Lancaster, CA 93524 | 2007-09-14 |
| 1336655943 | Keith Janda | Physician Assistant | 95th Medical Group 30 Nightingale Road Building 5525, Edwards Afb, CA 93524-0001 | 2017-12-19 |
| 1598286049 | Mackenzie Johnson Clevenger | Pharmacist | 412 Mdg 30 Nightingale Rd, Edwards Afb, CA 93524-0001 | 2017-07-05 |
| 1245751460 | Brandon John Potters | Military Health Care Provider | Air Test and Evaluation Squadron Nine Rd 187 Rd, Edwards Afb, CA 93524-0001 | 2017-06-28 |
| 1003266073 | Meshva Akwalia | Pediatrics | 412 Medical Group 30 Nightingale Rd Bldg 5525, Edwards Afb, CA 93524-0001 | 2016-06-20 |
| 1144613670 | Pang Ko | Dentist | 30 Nightingale Ave Building 5513, Edwards, CA 93524-0001 | 2015-03-09 |
| 1710293345 | Tonya Nicole Barry | Dentist | Bldg 3925, 31 Nightingale Rd, Edwards Afb, CA 93524-0001 | 2010-08-20 |
| 1265761340 | Shanda R. Marshall | Nurse Practitioner | 412 Th Medical Grouup, 30 Nightingale Road, Edwards, CA 93524-0001 | 2009-12-18 |
| Find all providers in zip 93524 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
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| Find all providers with the same taxonomy | ||||
| City | EDWARDS AFB |
| Zip Code | 93524 |
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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.