NORTHERN NEVADA MEDICAL GROUP, LLC (NPI# 1972751618) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972751618 |
| Entity Type | Organization |
| Organization Name | NORTHERN NEVADA MEDICAL GROUP, LLC |
| Practice Address |
2345 E Prater Way Suite 207 Sparks NV 89434-9600 |
| Mailing Address |
2345 E Prater Way Ste 207 Sparks NV 89434-9600 |
| Practice Telephone | 7753525300 |
| Practice Fax Number | 7753525334 |
| Mailing Telephone | 7753569393 |
| Mailing Fax Number | 7753565590 |
| Enumeration Date | 2008-09-06 |
| Last Update Date | 2020-08-17 |
| Authorized Official Name | MR. TODD EVANS (VP) |
| Authorized Official Telephone | 6107683300 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
Allopathic & Osteopathic Physicians | ||
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208M00000X | Hospitalist | Allopathic & Osteopathic Physicians | ||
| N | 213E00000X | Podiatrist | Podiatric Medicine & Surgery Service Providers | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
Allopathic & Osteopathic Physicians | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NV | 1972751618 | 05 | |
| NV | RR MEDICARE | DO8810 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376891572 | Northern Nevada Medical Group, LLC | Durable Medical Equipment & Medical Supplies | 2385 E Prater Way, Suite 300, Sparks, NV 89434-9629 | 2012-08-17 |
| Street Address |
2345 E PRATER WAY SUITE 207 |
| City | SPARKS |
| State | NV |
| Zip Code | 89434-9600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326044520 | Ronald B. Hicks II | Family Medicine | 2345 E Prater Way, Ste 301, Sparks, NV 89434-9639 | 2005-06-22 |
| 1720443708 | Sieu Long | Pharmacist | 2345 E Prater Way, Ste.111, Sparks, NV 89434-9600 | 2015-12-17 |
| 1093028565 | Innerthin LLC | Family Medicine | 2345 E Prater Way, Ste. 200, Sparks, NV 89434-9600 | 2010-07-26 |
| 1235369646 | High Desert Family Medicine Inc. | Family Medicine | 2345 E Prater Way, Ste. 301, Sparks, NV 89434-9600 | 2009-07-20 |
| 1093954760 | Vijaya Veena Bayya | Internal Medicine | 2345 E Prater Way, Suite 104, Sparks, NV 89434-9600 | 2009-02-19 |
| 1396980942 | Keiko Case | Dietitian, Registered | 2345 E Prater Way, Sparks, NV 89434-9600 | 2008-12-11 |
| 1356594840 | Elizabeth R Jaffe Md Prof. Corp | Family Medicine | 2345 E Prater Way, Suite 215, Sparks, NV 89434-9600 | 2008-10-28 |
| 1962686840 | Katheryne W Glantz Ltd | Podiatrist | 2345 E Prater Way, #315, Sparks, NV 89434-9600 | 2007-12-27 |
| 1306975198 | University of Nv School of Med Multispecialty Group Practice North Inc | Obstetrics & Gynecology | 2345 E Prater Way, 211, Sparks, NV 89434-9600 | 2007-03-05 |
| 1821174145 | Katheryne W Glantz | Podiatrist | 2345 E Prater Way, 315, Sparks, NV 89434-9639 | 2006-10-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750992210 | Erin Heffelfinger | Rehabilitation Practitioner | 550 Marina Gateway Dr, Apt 1432, Sparks, NV 89434 | 2020-08-10 |
| 1568009892 | Daniel Wesley Jacobson | Home Health Aide | 800 Nichols Bldv #222, Sparks, NV 89434 | 2019-12-05 |
| 1437649688 | Barbara M Robinson | Home Health Aide | 1963 E. Prayer Way, Sparks, NV 89434 | 2018-05-14 |
| 1851788277 | P6 Family Services LLC | Case Management | 2200 North D'andrea Pkwy #2411, Sparks, NV 89434 | 2015-04-23 |
| 1700188430 | Etxea Services | Community/Behavioral Health | 741 Rancho Villa Drive, Sparks, NV 89434 | 2010-12-01 |
| 1194970640 | Steven Joel Madison | Registered Nurse | 1999 Mania Court, Sparks, NV 89434 | 2008-11-25 |
| 1730342155 | Raymond Miranda Duro | Pharmacist | 2375 East Prater Way Sparks, Sparks, NV 89434 | 2008-07-07 |
| 1124293436 | Steve D Smith | Hearing Instrument Specialist | 1450 E Prater Way Ste 111, Sparks, NV 89434 | 2008-04-28 |
| 1437355799 | Kristin Leigh Koetje | Social Worker | 310 Rue De La Lavanda, Sparks, NV 89434 | 2007-06-25 |
| 1063549582 | Urology Institute | Urology | 2385 E Prater Way Suite 112, Sparks, NV 89434 | 2007-02-28 |
| Find all providers in zip 89434 | ||||
| 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 |
|---|---|---|---|---|
| 1164934824 | Martin L. Moore Apc | Family Medicine | 5050 Chappelet Dr, Sparks, NV 89436-8132 | 2017-11-02 |
| 1912041658 | Katharine Starr Bennett | Family Medicine | 3380 N Truckee Ln, Sparks, NV 89434-1570 | 2007-02-16 |
| 1518016393 | Phillis Maxine Boyd | Family Medicine | 2125 Green Vista Dr, Suite 106, Sparks, NV 89431-8545 | 2007-01-09 |
| 1376602573 | Paul N Mcclintock | Family Medicine | 2281 Pyramid Way Suite 9, Sparks, NV 89431-2161 | 2006-12-06 |
| 1316010846 | Jeffrey David Millman | Family Medicine | 1321 N Mccarran Blvd, Suite 103, Sparks, NV 89431 | 2006-11-15 |
| 1437162864 | William Clearfield | Family Medicine | 1625 E Prater Way Ste 103, Sparks, NV 89434-8963 | 2006-08-15 |
| 1851348932 | Charles A. Romick | Family Medicine | 2205 Glendale Ave, #131, Sparks, NV 89431-5511 | 2006-05-27 |
| 1205809365 | Sangeeta S. Wagner | Family Medicine | 5265 Vista Blvd Bldg B, Sparks, NV 89436-0836 | 2006-02-09 |
| 1124006044 | Diane M Thomas | Family Medicine | 4868 Sparks Blvd, Suite 102, Sparks, NV 89436-8207 | 2006-01-03 |
| 1083691927 | Hyun Jung Hong | Family Medicine | 4834 Sparks Blvd, Suite 100, Sparks, NV 89436-8215 | 2005-12-30 |
| Find all providers in SPARKS | ||||
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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.