FAIRMONT AVE CARE CENTER
NPI 1174570964
Internal Medicine in Lodi, CA
NPI Status: Active since May 27, 2006
Contact Information
999 S FAIRMONT AVE
#130/135
LODI, CA
ZIP 95240
Phone: (209) 366-2001
- Organization
- Internal Medicine
- CLIA Number: 05D0706846
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 09-24-2026
About FAIRMONT AVE CARE CENTER
This page provides the complete NPI Profile along with additional information for Fairmont Ave Care Center, an internist established in Lodi, California operating as a Internal Medicine. The healthcare provider is registered in the NPI registry with number 1174570964 assigned on May 2006. The practitioner's primary taxonomy code is 207R00000X. The provider is registered as an organization and their NPI record was last updated 16 years ago. Fairmont Ave Care Center operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The provider's is doing business as Fairmont Ave Care Center. The authorized official of this NPI record is Steven A Mitnick Md (Medical Director)
- NPI
- 1174570964
- Provider Legal Name
- SUTTER GOULD MEDICAL FOUNDATION
- Other Organization Name
- FAIRMONT AVE CARE CENTER
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 999 S FAIRMONT AVE #130/135 LODI, CA 95240
- Location Phone
- (209) 366-2001
- Mailing Address
- 600 COFFEE RD MODESTO, CA 95355
- Mailing Phone
- (209) 524-1211
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 05-27-2006
- Last Update Date
- 05-06-2010
- Code Navigator
An internist like Fairmont Ave Care Center is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.
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
Internal Medicine
- Taxonomy Code
- 207R00000X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| ZZZ20685Z | MEDICARE ID-TYPE UNSPECIFIED (04) | CA | MEDICARE NUMBER |
| 0586060021 | MEDICARE NSC (07) | CA |
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
- 05D0706846
- Facility Type
- Physician Office
- Certificate Effective Date
- September 25, 2024
- Certificate Expiration Date
- September 24, 2026
- Laboratory Director
- PATRICIA KENNEL
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Fairmont Ave Care Center in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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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 1174570964, we treat the final digit (4) 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 56. The final step is to find the difference between that total and the next multiple of ten (60 - 56 = 4).
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 56 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
LODI, CA 95240
LODI, CA 95240
LODI, CA 95240
LODI, CA 95240
LODI, CA 95240
LODI, CA 95240
LODI, CA 95240
LODI, CA 95240
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1174570964, enumerated as an "organization" on May 27, 2006.
The provider is located at 999 S FAIRMONT AVE #130/135 LODI, CA 95240 and the phone number is (209) 366-2001.
Internal Medicine with taxonomy code 207R00000X.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
