Merced Faculty Associates Medical Group, Incorporated
Organization Active NPI Family Medicine Physician · Merced, CA
NPI 1003231341 · NPPES record last updated Sep 29, 2015
Key facts
- NPI
- 1003231341
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MERCED FACULTY ASSOCIATES MEDICAL GROUP, INCORPORATED
- Practice address
- 3393 G St
Suite C
Merced, CA 95340-0964 - Phone
- (209) 725-7149
- NPI assigned
- Feb 24, 2014
- Organization subpart
- No
Authorized official
- Name
- Rebecca Shaw
- Title
- Ceo
- Phone
- (209) 761-4555
Other NPIs on the same Medicare enrollment 15
Corporate family (same tax ID) 9
Practitioners 9
-
Chela Marie Hinesley, PAC RD
-
Marvi Miranda, M.D.
-
Bao Thao, FNP
-
Maiya Drue Thao, DPM
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2078496 | Mfa G Street | Provider-performed microscopy | May 28, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040409000199 | CA | Part B Supplier - Clinic/Group Practice | 4789678111 |
Receives reassigned benefits from 49 practitioners 15 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Atwater, CA; Merced, CA; Livingston, CA; Hilmar, CA; Delhi, CA |
National Provider Directory
- Tax ID family
- Merced Faculty Associates Medical Group Incorporated
Interoperability endpoints
- https://api.platform.athenahealth.com/3012/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | CA | Yes |
Addresses
Primary practice location
3393 G St
Suite C
Merced, CA 95340-0964
Mailing address
PO Box 3768
Merced, CA 95344-3768
Phone (209) 725-7149
Other names
- MFA G Street
Other providers in Merced, CA
- Merced Faculty Associates Medical Group Incorporated
- Merced Faculty Associates Medical Group Incorporated
- Merced Faculty Associates Medical Group Incorporated
- Merced Faculty Associates Medical Group Incorporated
- Merced Faculty Associates Medical Group Incorporated
- Merced Gastroenterology Medical Office Inc
- Merced General Surgery Inc
- Merced Health Care Inc.
- Merced Health Care Inc.
- Merced Heart Associates
All providers in Merced, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.