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REDWOOD PEDIATRIC MEDICAL GROUP
NPI 1164574083
Specialist in Fortuna, CA

Active since January 18, 2007CLIA 05D0613017 · Waiver
3305 RENNER DR, FORTUNA, CA 95540(707) 725-9355(707) 725-2426 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Redwood Pediatric Medical Group NPPES

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

REDWOOD PEDIATRIC MEDICAL GROUP (NPI 1164574083) is a healthcare organization registered as a specialist in Fortuna, California and active in the NPI registry since January 2007. The organization holds a CLIA Waiver certificate valid through December 31, 2026 and lists Shalamar Ivey, Billing Manager, as its authorized official.

NPPES Registry Identity

NPI1164574083
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameREDWOOD PEDIATRIC MEDICAL GROUP
Location Address3305 RENNER DRFortuna, CA 95540-3119
Mailing Address3305 Renner DrFortuna, CA 95540-3119 · Fax (707) 725-2426
Phone(707) 725-9355
Fax(707) 725-2426
Organization SubpartNo
Authorized OfficialShalamar IveyBilling Manager · (707) 725-9355
Enumeration DateJanuary 18, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1164574083 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in CA · G082256
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
3305 RENNER DR, Fortuna, CA 95540
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

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 05D0613017

Redwood Pediatric Medical Group · Fortuna, CA
Active · expires Dec 31, 2026
CLIA Number05D0613017
Laboratory TypePhysician Office
Certificate Effective DateJanuary 1, 2025
Certificate Expiration DateDecember 31, 2026
Laboratory DirectorJames Killfoil, MD
Laboratory Phone(707) 725-9355
Laboratory LocationRedwood Pediatric Medical Group3305 Renner Drive, Fortuna, CA 95540
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

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

DR. ERIKA NMI ROSENBERG M.D.
Specialist
3305 RENNER DR
FORTUNA, CA 95540
Humboldt County (707) 725-9355
LAURA L MOJICA APRN, IBCLC, CPNP-PC
Nurse Practitioner (Pediatrics)
3305 RENNER DR
FORTUNA, CA 95540
Humboldt County (707) 725-9355
DR. JAMES JOHN KILLFOIL M.D.
Specialist
3305 RENNER DR
FORTUNA, CA 95540
Humboldt County (707) 725-9355
JOHN MOGEL M.D.
Specialist
3305 RENNER DR
FORTUNA, CA 95540
Humboldt County (707) 725-9355

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 Redwood Pediatric Medical Group's NPI number?

The NPI number for Redwood Pediatric Medical Group is 1164574083. It was assigned to this organization in the NPPES registry on January 18, 2007.

Where is Redwood Pediatric Medical Group located?

Redwood Pediatric Medical Group is located at 3305 Renner Dr, Fortuna, CA 95540. The listed phone number is (707) 725-9355.

What is Redwood Pediatric Medical Group's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Redwood Pediatric Medical Group hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0613017) is associated with this NPI, valid through December 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Redwood Pediatric Medical Group was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.