NPIMap

Organization Active NPI

Central Valley Dermatology Medical Group, a Professional Corporation

Doing business as Central Valley Dermatology Medical Group

  • Dermatology Physician
  • Turlock, CA
National Provider Identifier
1043315195
Registry record updated May 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
CENTRAL VALLEY DERMATOLOGY MEDICAL GROUP, A PROFESSIONAL CORPORATION
Doing business as
Central Valley Dermatology Medical Group
Practice address
3800 Geer Rd Ste 200
Turlock, CA 95382-1146
Phone
(209) 250-1442
Fax
(209) 668-4992
NPI assigned
Sep 13, 2006
Last updated
May 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Basil M Hantash, MD, PHDNPI 1942248083
Title
President
Phone
(408) 204-8946

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary

Addresses

Primary practice location

3800 Geer Rd Ste 200
Turlock, CA 95382-1146

Mailing address

3800 Geer Rd Ste 200
Turlock, CA 95382-1146
Phone (209) 250-1442

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ20312ZOtherMEDICARE GROUP ID#
DA7300OtherRAILROAD MEDICARE GROUP#

Other names 1

  • Central Valley Dermatology Medical Group Doing business as

National Provider Directory

National Provider Directory

Locations

423 Lincoln Ctr
Stockton, CA 95207

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1043315195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 GEER RD STE 200",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953821146",
            "telephone_number": "209-250-1442",
            "fax_number": "209-668-4992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 GEER RD STE 200",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953821146",
            "telephone_number": "209-250-1442",
            "fax_number": "209-668-4992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL VALLEY DERMATOLOGY MEDICAL GROUP, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "HANTASH",
        "authorized_official_first_name": "BASIL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "408-204-8946",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP ID#",
            "identifier": "ZZZ20312Z",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP#",
            "identifier": "DA7300",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Valley Dermatology Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Turlock, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.