| Ikigai Physician Group Inc | |
|
3429 Renner Dr Fortuna CA 95540-3104 | |
| (707) 726-2255 | |
| (707) 949-9715 |
| Full Name | Ikigai Physician Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 3429 Renner Dr, Fortuna, California |
| Authorized Official Name and Position | Barbara Sisson (ADMINISTRATOR) |
| Authorized Official Contact | 7074961828 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ikigai Physician Group Inc 3429 Renner Dr Fortuna CA 95540-3104 Ph: (707) 726-2255 | Ikigai Physician Group Inc 3429 Renner Dr Fortuna CA 95540-3104 Ph: (707) 726-2255 |
| NPI Number | 1043830813 |
|---|---|
| Provider Enumeration Date | 04/22/2020 |
| Last Update Date | 11/10/2021 |
| Medicare PECOS PAC ID | 7012332208 |
|---|---|
| Medicare Enrollment ID | O20200805001037 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043830813 | NPI | - | NPPES |
| 123456 | Other | CA | FAMILY MEDICINE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208M00000X | Hospitalist | (* (Not Available)) | Secondary |
| Provider Name | Stephanie Suzanne Dittmer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942422688 PECOS PAC ID: 4082768809 Enrollment ID: I20131115000255 |
| Provider Name | Katherine A Estlin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255574885 PECOS PAC ID: 8426208547 Enrollment ID: I20161024002461 |
| Provider Name | Steven Aussenberg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174902936 PECOS PAC ID: 8224343975 Enrollment ID: I20190424002450 |
Ikigai Physician Group Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3429 Renner Dr, Fortuna, CA 95540 Phone: 707-726-2255 Fax: 707-949-9715 | |
Providence Family Practice Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3302 Renner Dr, Fortuna, CA 95540 Phone: 707-725-3318 | |
Ikigai Physician Group Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3429 Renner Dr, Fortuna, CA 95540 Phone: 707-726-2255 Fax: 707-949-9715 | |
Redwoods Rural Health Center, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 930 S Fortuna Blvd, Fortuna, CA 95540 Phone: 707-353-2162 | |
Fortuna Family Medical Group Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 874 Main St, Fortuna, CA 95540 Phone: 707-725-3334 Fax: 707-725-2455 | |
Fortuna Family Medicine Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2404 Newburg Rd, Fortuna, CA 95540 Phone: 707-725-3334 Fax: 707-725-2455 |