REDWOOD PEDIATRIC MEDICAL GROUP
NPI 1164574083
Specialist in Fortuna, CA
NPI Status: Active since January 18, 2007
Contact Information
3305 RENNER DR
FORTUNA, CA
ZIP 95540
Phone: (707) 725-9355
Fax: (707) 725-2426
- Organization
- Specialist
- CLIA Number: 05D0613017
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 12-31-2026
About REDWOOD PEDIATRIC MEDICAL GROUP
This page provides the complete NPI Profile along with additional information for Redwood Pediatric Medical Group, a provider established in Fortuna, California operating as a Specialist. The healthcare provider is registered in the NPI registry with number 1164574083 assigned on January 2007. The practitioner's primary taxonomy code is 174400000X with license number G082256 (CA). The provider is registered as an organization and their NPI record was last updated 6 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Mrs. Shalamar Ivey (Billing Manager)
- NPI
- 1164574083
- Provider Name
- REDWOOD PEDIATRIC MEDICAL GROUP
- Entity Type
- Organization
- Location Address
- 3305 RENNER DR FORTUNA, CA 95540
- Location Phone
- (707) 725-9355
- Location Fax
- (707) 725-2426
- Mailing Address
- 3305 RENNER DR FORTUNA, CA 95540
- Mailing Fax
- (707) 725-2426
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-18-2007
- Last Update Date
- 08-22-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Specialist
- Taxonomy Code
- 174400000X
- Type
- Other Service Providers
- License No.
- G082256
- License State
- CA
- Taxonomy Description
- 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.
Group Taxonomy 193400000X MULTIPLE SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 05D0613017
- Facility Type
- Physician Office
- Certificate Effective Date
- January 01, 2025
- Certificate Expiration Date
- December 31, 2026
- Laboratory Director
- JAMES KILLFOIL, MD
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Redwood Pediatric Medical Group to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1164574083, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 57. The final step is to find the difference between that total and the next multiple of ten (60 - 57 = 3).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 57 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 4 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1164574083, enumerated as an "organization" on January 18, 2007.
The provider is located at 3305 RENNER DR FORTUNA, CA 95540 and the phone number is (707) 725-9355.
Specialist with taxonomy code 174400000X.
