MR. LARIN TIMOTHY CLARK (NPI# 1245792332) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245792332 |
| Entity Type | Individual |
| Full Name | MR. LARIN TIMOTHY CLARK |
| Credential | IDMT |
| Practice Address |
101 Bodin Cir Travis Afb CA 94535-1809 |
| Practice Telephone | 7074233727 |
| Mailing Telephone | 7074233727 |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2019-04-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| Street Address |
101 BODIN CIR |
| City | TRAVIS AFB |
| State | CA |
| Zip Code | 94535-1809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801893276 | Charles A Tujo | Radiology | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2005-06-30 |
| 1538769351 | Chelsey Violet Pelkey | Military Health Care Provider | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2020-10-30 |
| 1538768114 | Jordan Rose | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2020-10-23 |
| 1821606591 | Madelyn Hale | Military Health Care Provider | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2020-07-20 |
| 1932727856 | Julie Thein | Audiologist | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2020-07-07 |
| 1063039501 | Shae Daniel Bryant | Dentist | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2020-07-01 |
| 1598381089 | Aaron J Surbaugh | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2020-06-19 |
| 1194348466 | Amanda Vance | Registered Nurse | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2020-05-21 |
| 1427681196 | Bradley Burkey | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2020-02-20 |
| 1821629288 | Gloria Calvillo | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2020-02-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508487711 | Sheila C Flood | Student in an Organized Health Care Education/Training Program | 101 Biden Circle, Fairfield, CA 94535 | 2020-04-28 |
| 1568081255 | Miguel Julian Moreno | Student in an Organized Health Care Education/Training Program | 690 Airmen Drive, Travis Afb, CA 94535 | 2020-04-13 |
| 1174096101 | Zlatoslava Karga | Nurse Practitioner | 60mdg / Sgow, 101 Bodin Circle, Travis Afb, CA 94535 | 2019-01-02 |
| 1437648292 | Luke C Vera | Dentist | David Grant Medical Center 101 Bodin Circle, Travis Air Force Base, CA 94535 | 2018-05-08 |
| 1588163430 | Sanaz Ziad | Pharmacist | 60mdg/mdts, 101 Bodin Circle, Travis Afb, CA 94535 | 2018-02-06 |
| 1194265686 | Geoffrey Johnston | Dentist | 60 Mdg/sgdd, 101 Bodin Circle, Travis Afb, CA 94535 | 2017-03-02 |
| 1336693407 | Hannah Isla Nordwall | Social Worker | 60 Mdg/mdos 101 Bodin Cir, Travis Afb, CA 94535 | 2016-08-06 |
| 1184177149 | Taylor Murrie-robinson | Social Worker | 60mdg / Sgow Mental Health Clinic, 101 Bodin Circle, Travis Afb, CA 94535 | 2016-07-26 |
| 1952759607 | Eric Kincaid-sharp | General Practice | 60 Mdg/amds, 101 Bodin Cir, Travis Afb, CA 94535 | 2016-06-02 |
| 1023472040 | Genieve Marie Martinez-hernandez | Internal Medicine | 60 Mdg/sgomi, 101 Bodin Circle, Fairfield, CA 94535 | 2016-04-06 |
| Find all providers in zip 94535 | ||||
| Taxonomy Code | 1710I1003X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Medical Technicians |
| An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. |
| Notes: Source: Air Force Surgeon General Office [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598182214 | Matthew Wheaton Burns | Military Health Care Provider | 105 Colorado St, Travis Afb, CA 94535-1255 | 2014-03-19 |
| 1760740484 | Rebecca Lee Flores | Military Health Care Provider | 60mdg/60 Mdos, 101 Bodin Circle, Travis Afb, CA 94535-1800 | 2012-05-01 |
| 1750648879 | Dwinese Marise Aird | Military Health Care Provider | 113 Colorado Street, Travis Afb, CA 94535 | 2012-04-13 |
| 1477861474 | Bernard Pillagara Bueno | Military Health Care Provider | 137 Maine Street, Travis Afb, CA 94535 | 2010-09-24 |
| 1366775355 | Douglas Dwight Caldwell II | Military Health Care Provider | 150 Fitzgerald Dr, Travis Afb, CA 94535-1205 | 2009-09-09 |
| 1255566915 | Keith John Barton | Military Health Care Provider | 531 Waldron St Ste D, 349th Aerospace Medicine Sqadron, Travis Afb, CA 94535-2125 | 2009-05-26 |
| 1538769351 | Chelsey Violet Pelkey | Military Health Care Provider | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2020-10-30 |
| 1821606591 | Madelyn Hale | Military Health Care Provider | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2020-07-20 |
| 1649810458 | Andrew Lawrence Pierson | Military Health Care Provider | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2020-01-09 |
| 1508406596 | Ivette Mariana Brueggemann | Military Health Care Provider | 101 Bodin Cir, Travis Afb, CA 94535-1809 | 2020-01-08 |
| Find all providers in TRAVIS AFB | ||||
| City | TRAVIS AFB |
| Zip Code | 94535 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.