KAISER PERMANENTE (NPI# 1922337864) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922337864 |
| Entity Type | Organization |
| Organization Name | KAISER PERMANENTE |
| Practice Address |
1761 Broadway St 100 Vallejo CA 94589-2226 |
| Mailing Address |
1761 Broadway St 100 Vallejo CA 94589 |
| Practice Telephone | 7076452700 |
| Practice Fax Number | 7076452181 |
| Mailing Telephone | 7076452700 |
| Mailing Fax Number | 7076452181 |
| Enumeration Date | 2009-12-23 |
| Last Update Date | 2009-12-23 |
| Authorized Official Name | TRACIE LEE KEPLER HOFFMAN (MFT) |
| Authorized Official Telephone | 7076452700 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
MFC 47228 | CA | Ambulatory Health Care Facilities |
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
MFC 47228 | CA | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588198402 | Kaiser Permanente | Medicare Defined Swing Bed Unit | 9945 Valgrande Way, Elk Grove, CA 95757-3004 | 2017-04-18 |
| 1205377611 | Kaiser Permanente | Clinic/Center | 965 N Humboldt St, Apt 201, Denver, CO 80218-3563 | 2017-03-17 |
| 1710427539 | Kaiser Permanente | Pharmacist | 10601 Viscaino Pl, Bakersfield, CA 93311-3153 | 2017-02-27 |
| 1255877635 | Kaiser Permanente | Clinic/Center | 1451 24th Street, Apt 146, Denver, CO 80205 | 2017-01-10 |
| 1073062832 | Kaiser Permanente | General Acute Care Hospital | 4932 Santiago Drive, La Palma, CA 90623 | 2016-09-22 |
| 1043767445 | Kaiser Permanente | Health Maintenance Organization | 5381 W Baseline Rd, Hillsboro, OR 97123-6447 | 2016-09-02 |
| 1154782936 | Kaiser Permanente | Clinic/Center | 2238 Geary Blvd Rm 5c063, San Francisco, CA 94115-3416 | 2016-03-08 |
| 1427417666 | Kaiser Permanente | General Acute Care Hospital | 1041 Elkgrove Ave, Apartment #4, Venice, CA 90291-3191 | 2016-02-16 |
| 1699148593 | Kaiser Permanente | Health Maintenance Organization | 25965 S. Normandie Aveune, Harbor City, CA 90710 | 2015-11-02 |
| 1275905101 | Kaiser Permanente | Health Maintenance Organization | 1800 Harrison St Fl 13th, Unit 1, Oakland, CA 94612-3471 | 2015-10-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | KAISER PERMANENTE | 1800 Harrison St Fl 16, Oakland, CA 94612-3466 |
| Virginia Business Entities | KAISER PERMANENTE INSURANCE COMPANY | 300 Lakeside Dr, Oakland, California 94612-3534 |
| Colorado Business Entities | KAISER PERMANENTE INSURANCE COMPANY | 300 Lakeside Drive, Oakland, CA 94612 |
| Street Address |
1761 BROADWAY ST 100 |
| City | VALLEJO |
| State | CA |
| Zip Code | 94589-2226 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316901689 | Esker-d Ligon | Nurse Practitioner | 1761 Broadway St, Suite 100, Vallejo, CA 94589-2226 | 2006-04-13 |
| 1013452119 | Jamie Lutat | Occupational Therapist | 1761 Broadway St, Vallejo, CA 94589-2226 | 2016-12-27 |
| 1962864785 | The Permanente Medical Group | Health Maintenance Organization | 1761 Broadway St, Suite 100, Vallejo, CA 94589-2226 | 2016-03-22 |
| 1063824019 | Shasta Marie Ihorn | Psychologist | 1761 Broadway St, Ste 100, Vallejo, CA 94589-2226 | 2014-05-27 |
| 1851734495 | Jonah Raphael Paquette | Psychologist | 1761 Broadway St, Suite 100, Vallejo, CA 94589-2226 | 2013-04-13 |
| 1659616043 | Lisa Michelle Termansen | Audiologist | 1761 Broadway St, Suite 200, Vallejo, CA 94589-2226 | 2012-12-11 |
| 1609134824 | Carol Lynn Ferro | Psychiatry & Neurology | 1761 Broadway St, Ste 100, Vallejo, CA 94589-2226 | 2012-04-25 |
| 1902175763 | Tina Loan Kim Hua | Pharmacist | 1761 Broadway St, Vallejo, CA 94589-2226 | 2011-12-23 |
| 1164790432 | Kristin Lee Koperski | Psychologist | 1761 Broadway St, Suite 100, Vallejo, CA 94589-2226 | 2011-12-01 |
| 1174843429 | Tracie Lee Kepler Hoffman | Marriage & Family Therapist | 1761 Broadway St, Suite 100, Vallejo, CA 94589-2226 | 2010-06-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366903478 | Nabreea Dianna Moore | Behavioral Analyst | 1300 Donner Pass Rd, Vallejo, CA 94589 | 2019-03-29 |
| 1588131221 | Alejandra Hernandez De Leon | Behavioral Analyst | 151 Mimosa Ct, Vallejo, CA 94589 | 2018-10-31 |
| 1821588948 | Angela Ancheta Laco | Behavioral Analyst | 71 Los Cerritos Dr, Vallejo, CA 94589 | 2018-05-14 |
| 1851750764 | Shauntell Hudson | Counselor | 112 Basalt Dr, Vallejo, CA 94589 | 2016-02-19 |
| 1982997680 | Shuttle California Transit, LLC | Private Vehicle | 322 Lemon St, Vallejo, CA 94589 | 2011-05-27 |
| 1588813455 | Shay Teresa Loftus | Psychologist | 1761 Broadway, Suite 100, Vallejo, CA 94589 | 2008-09-16 |
| 1063629236 | Michael Francis Edziak | Dentist | 150 Hospital Dr., Vallejo, CA 94589 | 2007-05-17 |
| 1346454220 | Diljit Bahuleyan Karayil | Internal Medicine | 975 Sereno Drive, Medical Office- 8, Kaiser Permanente Medical Center, Vallejo, CA 94589 | 2007-05-09 |
| 1174745525 | Thomas Welch Gross | Emergency Medicine | Emergency Dept., Kaiser Permanente Medical Center, 675 Sereno Dr, Vallejo, CA 94589 | 2007-05-03 |
| 1639207756 | James D Prigmore | Dentist | 1620 Valle Vista Ave, Ste 100, Vallejo, CA 94589 | 2007-03-01 |
| Find all providers in zip 94589 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
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| 1821607771 | Tonya Octave, Lcsw, Prof Corp | Clinic/Center | 237 S Lakeview Ave Ste A, Placentia, CA 92870-6756 | 2020-07-27 |
| 1972121762 | Environmental Alternatives Susanville | Clinic/Center | 2003 Main St, Susanville, CA 96130-4501 | 2020-07-08 |
| 1083231781 | Treehouse Child Therapy Professional Corporation | Clinic/Center | 514 N California Ave Ste 13, Beaumont, CA 92223-2120 | 2020-06-29 |
| 1083230262 | Socal Adolescent Wellness, Inc. | Clinic/Center | 23072 Lake Center Dr Ste 214, Lake Forest, CA 92630-2899 | 2020-06-23 |
| 1447876123 | P.h.i.l.o.s.adolescent Treatment Centers, Inc. | Clinic/Center | 454 E Cerritos St, Rialto, CA 92376-3658 | 2020-06-18 |
| 1669098505 | Rowi Valencia, Inc. | Clinic/Center | 27413 Tourney Rd Ste 150, Valencia, CA 91355-5604 | 2020-06-16 |
| 1386267870 | Bni Treatment Centers | Clinic/Center | 2563 Stokes Canyon Rd, Calabasas, CA 91302-2991 | 2020-05-19 |
| 1538781042 | P.h.i.l.o.s.adolescent Treatment Centers, Inc. | Clinic/Center | 3872 Carthage St, Riverside, CA 92501-2102 | 2020-05-07 |
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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.