NPI Record of CERES CARE CENTER (SUTTER GOULD MEDICAL FOUNDATION) NPI 1780631820

Family Medicine in Ceres, CA

Complete NPI Record

Field Name Value Definition
NPI1780631820The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameSUTTER GOULD MEDICAL FOUNDATIONThe name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization NameCERES CARE CENTEROther name by which the organization provider is or has been known.
Provider Other Organization Name Type Code3Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address600 COFFEE RDThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameMODESTOThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameCAThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code953554201The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number2095241211The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address2516 E WHITMORE AVEThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCERESThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameCAThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code953072645The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number2095381733The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date5/27/2006The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date5/6/2010The date that a record was last updated or changed.
Authorized Official Last NameMITNICKThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameSTEVENThe first name of the authorized official.
Authorized Official Middle NameAThe middle name of the authorized official.
Authorized Official Title or PositionMEDICAL DIRECTORThe title or position of the authorized official.
Authorized Official Telephone Number2095216097The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1208000000XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1N
Healthcare Provider Taxonomy Code 2207Q00000X
Healthcare Provider Primary Taxonomy Switch 2Y
Is Organization SubpartN
Authorized Official Credential TextMD
Healthcare Provider Taxonomy Group 1193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2193200000X MULTI-SPECIALTY GROUP