| NPI |
1750503538 |
The 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 Code |
1 |
Code 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). |
| Provider Last Name Legal Name |
THREDE |
The last name of the provider. If the provider is an individual, this is the legal name. |
| Provider First Name |
CAROL |
The first name of the provider, if the provider
is an individual. |
| Provider First Line Business Practice Location Address |
9100 BRENTWOOD BLVD |
The 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 Name |
BRENTWOOD |
The city name in the location address of the provider being identified. |
| Provider Business Practice Location Address State Name |
CA |
The State code in the location of the provider
being identified. |
| Provider Business Practice Location Address Postal Code |
945134000 |
The 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 |
US |
The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Telephone Number |
9258097920 |
The telephone number associated with the location address of the provider being identified. |
| Provider Business Practice Location Address Fax Number |
9258097928 |
The fax number associated with the location
address of the provider being identified. |
| Provider Enumeration Date |
5/3/2007 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date |
2/5/2008 |
The date that a record was last updated or changed. |
| Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
| Healthcare Provider Taxonomy Code 1 |
101YA0400X |
Code 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 1 |
Y |
|
| Healthcare Provider Taxonomy Code 2 |
251S00000X |
|
| Healthcare Provider Primary Taxonomy Switch 2 |
N |
|
| Other Provider Identifier 1 |
0726 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 1 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 1 |
CA |
|
| Other Provider Identifier Issuer 1 |
MEDI-CAL PROVIDER NUMBER |
|
| Other Provider Identifier 2 |
0753 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 2 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 2 |
CA |
|
| Other Provider Identifier Issuer 2 |
DRUG MEDI-CAL BILLING NUM |
|
| Other Provider Identifier 3 |
07556 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 3 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 3 |
CA |
|
| Other Provider Identifier Issuer 3 |
BYRON RANCH |
|
| Other Provider Identifier 4 |
07555 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 4 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 4 |
CA |
|
| Other Provider Identifier Issuer 4 |
DRUG COURT |
|
| Other Provider Identifier 5 |
07533 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 5 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 5 |
CA |
|
| Other Provider Identifier Issuer 5 |
ADOL TX ANTIOCH |
|
| Other Provider Identifier 6 |
07552 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 6 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 6 |
CA |
|
| Other Provider Identifier Issuer 6 |
DMC ADULT BRENTWOOD |
|
| Other Provider Identifier 7 |
075531 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 7 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 7 |
CA |
|
| Other Provider Identifier Issuer 7 |
ADULT TX ANTIOCH |
|
| Other Provider Identifier 8 |
07557 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 8 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 8 |
CA |
|
| Other Provider Identifier Issuer 8 |
DMC ADOL BRENTWOOD |
|
| Other Provider Identifier 9 |
070753 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 9 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 9 |
CA |
|
| Other Provider Identifier Issuer 9 |
MASTER PROVIDER NUMBER |
|
| Other Provider Identifier 10 |
070726 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 10 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 10 |
CA |
|
| Other Provider Identifier Issuer 10 |
MASTER PROVIDER NUMBER |
|
| Other Provider Identifier 11 |
07536 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 11 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 11 |
CA |
|
| Other Provider Identifier Issuer 11 |
DMC ADOL ANTIOCH |
|
| Other Provider Identifier 12 |
07551 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 12 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 12 |
CA |
|
| Other Provider Identifier Issuer 12 |
ADULT TX BRENTWOOD |
|
| Other Provider Identifier 13 |
07553 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 13 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 13 |
CA |
|
| Other Provider Identifier Issuer 13 |
ADOL TX BRENTWOOD |
|
| Other Provider Identifier 14 |
56682 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 14 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 14 |
CA |
|
| Other Provider Identifier Issuer 14 |
STAFF BILLING NUMBER |
|
| Other Provider Identifier 15 |
07534 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 15 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 15 |
CA |
|
| Other Provider Identifier Issuer 15 |
DMC ADULT ANTIOCH |
|
| Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |