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LODI AVE CARE CENTER
NPI 1063468106
Family Medicine in Lodi, CA

Active since May 26, 2006CLIA Certified · 3 labs
1300 W LODI AVE, STE P, LODI, CA 95242(209) 366-1990 Get Directions Write a Review

NPPES record last updated: May 6, 2010. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Lodi Ave Care Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LODI AVE CARE CENTER (NPI 1063468106) is a healthcare organization registered as a family medicine in Lodi, California and active in the NPI registry since May 2006. The organization holds 3 active CLIA laboratory certificates and lists Steven A Mitnick, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1063468106
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameSUTTER GOULD MEDICAL FOUNDATION
Location Address1300 W LODI AVE, STE PLodi, CA 95242-3000
Mailing Address600 Coffee RdModesto, CA 95355-4201 · (209) 524-1211
Phone(209) 366-1990
Organization SubpartNo
Authorized OfficialSteven A MitnickMedical Director · (209) 521-6097
Enumeration DateMay 26, 2006
Last NPPES UpdateMay 6, 2010
✔ NPI 1063468106 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition

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.

Also ListedPediatricsTaxonomy 208000000X
1300 W LODI AVE, Lodi, CA 95242
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Other Names 1

Doing Business AsLodi Ave Care Center

Other Identifiers 2

Medicare ID-Type UnspecifiedZZZ20685ZCA · Medicare Number
Medicare NSC0586060019CA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0609690

Sutter Gould Medical Foundation-Lodi Pediatrics · Lodi, CA
Active · expires Mar 22, 2028
CLIA Number05D0609690
Laboratory TypePhysician Office
Certificate Effective DateMarch 23, 2026
Certificate Expiration DateMarch 22, 2028
Laboratory DirectorMarina O. Castillo
Laboratory Phone(209) 365-8581
Laboratory LocationSutter Gould Medical Foundation-Lodi Pediatrics1300 W Lodi Ave Ste P (east), Lodi, CA 95242
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D0684421

Sutter Gould Medical Foundation - Lodi Family Medicine · Lodi, CA
Active · expires Mar 21, 2028
CLIA Number05D0684421
Laboratory TypePhysician Office
Certificate Effective DateMarch 22, 2026
Certificate Expiration DateMarch 21, 2028
Laboratory DirectorRichard W. Yee
Laboratory Phone(209) 988-3294
Laboratory LocationSutter Gould Medical Foundation - Lodi Family Medicine1300 West Lodi Avenue Ste P, Lodi, CA 95242
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 05D1050001

Sutter Gould Medical Foundation- Kettleman Care Center · Lodi, CA
Active · expires Jan 22, 2028
CLIA Number05D1050001
Laboratory TypePhysician Office
Certificate Effective DateJanuary 23, 2026
Certificate Expiration DateJanuary 22, 2028
Laboratory DirectorPaul Sackschewsky
Laboratory Phone(209) 988-3294
Laboratory LocationSutter Gould Medical Foundation- Kettleman Care Center1335 South Fairmont Avenue, Lodi, CA 95242
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KEVIN IRVING STROH DPM
Podiatrist
1300 W LODI AVE, STE W
LODI, CA 95242
San Joaquin County (209) 334-6664
KIMBERLY LYNN HAUNER NP
Nurse Practitioner (Pediatrics)
1300 W LODI AVE, SUITE P
LODI, CA 95242
San Joaquin County (209) 369-7493
ROY TSUTOMU ISHII MD
Pediatrics
1300 W LODI AVE, SUITE P
LODI, CA 95242
San Joaquin County (209) 369-7493
ABELARDO VERCELES MAYO MD
Pediatrics
1300 W LODI AVE, SUITE P
LODI, CA 95242
San Joaquin County (209) 369-7493
KIANA LEE NICOLE COX MD
Family Medicine
1300 W LODI AVE, SUITE P
LODI, CA 95242
San Joaquin County (209) 366-1990
RICHARD WYMAN YEE D.O.
Family Medicine
1300 W LODI AVE, SUTIE P
LODI, CA 95242
San Joaquin County (209) 366-1990
SAMINA QAMAR M.D.
Family Medicine
1300 W LODI AVE
LODI, CA 95242
San Joaquin County (209) 366-1990
MRS. MARTIE J CORYELL MFT
Marriage & Family Therapist
1300 W LODI AVE, A-5
LODI, CA 95242
San Joaquin County (209) 329-8941

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sutter Gould Medical Foundation's NPI number?

The NPI number for Sutter Gould Medical Foundation is 1063468106. It was assigned to this organization in the NPPES registry on May 26, 2006.

Where is Sutter Gould Medical Foundation located?

Sutter Gould Medical Foundation is located at 1300 W Lodi Ave Ste P, Lodi, CA 95242. The listed phone number is (209) 366-1990.

What is Sutter Gould Medical Foundation's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Sutter Gould Medical Foundation hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Sutter Gould Medical Foundation was last updated on May 6, 2010. NPI Profile syncs with the weekly NPPES data releases published by CMS.