NPIMap

Organization Active NPI

Your Medical Group, Inc

  • Family Medicine Physician
  • Hollister, CA
National Provider Identifier
1043630106
Registry record updated Apr 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
YOUR MEDICAL GROUP, INC
Practice address
591 McCray St
Suite 211
Hollister, CA 95023-2224
Phone
(831) 531-4213
NPI assigned
Apr 16, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2014

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

Authorized official

Name
Mr. Ray KusumotoNPI 1194850800
Title
Ceo-President
Phone
(831) 531-4213

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

591 McCray St
Suite 211
Hollister, CA 95023-2224

Mailing address

591 McCray St
Suite 211
Hollister, CA 95023-2224
Phone (831) 531-4213

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141218001632 CA Part B Supplier - Clinic/Group Practice 5395068563 Receives reassigned benefits from 10 practitioners
Practice locations: Hollister, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1397606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397606400000",
    "number": "1043630106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "591 MCCRAY ST",
            "address_2": "SUITE 211",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950232224",
            "telephone_number": "831-531-4213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 MCCRAY ST",
            "address_2": "SUITE 211",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950232224",
            "telephone_number": "831-531-4213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUR MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-16",
        "last_updated": "2014-04-16",
        "status": "A",
        "authorized_official_last_name": "KUSUMOTO",
        "authorized_official_first_name": "RAY",
        "authorized_official_title_or_position": "CEO-PRESIDENT",
        "authorized_official_telephone_number": "831-531-4213",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollister, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.