Cisco Medical Group, Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

CISCO MEDICAL GROUP, INC

Practice address

18518 Sherman Way
Reseda, CA 91335-4212

Phone

(818) 757-0954

Fax

(818) 757-0963

NPI assigned

Oct 10, 2006

Organization subpart

No

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

Authorized official

Name

Jose Francisco Martinez Cardenas, MDNPI 1700827052

Title

President/Medical Director

Phone

(818) 757-0954

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Cisco Medical Group - Reseda Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Cisco Medical Group, Inc

  • Primary Care Clinic/Center
  • Burbank, CA
  • NPI 1164097341

  O20050614000315

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Cisco Medical Group - Burbank2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Cisco Medical Group, Inc

  • Primary Care Clinic/Center
  • Burbank, CA
  • NPI 1164097341
  NPD tax ID

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25605/brand/1/csg/1/fhir/r4

Practitioners 4

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

• Jose Francisco Martinez Cardenas, M.D.

  • Internal Medicine Physician
  • Reseda, CA
  • NPI 1700827052
  Medicare reassignment Authorized official
• Carmen Cortez Ortega

  • Physician Assistant
  • Reseda, CA
  • NPI 1558911602
  Medicare reassignment NPD
• Annette E Saldana, M.D.

  • General Practice Physician
  • Reseda, CA
  • NPI 1205883527
  Medicare reassignment
• Poorvi P Shah, D.O.

  • Family Medicine Physician
  • Bloomfield Hills, MI
  • NPI 1306918073
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1053408989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18518 SHERMAN WAY",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913354212",
            "telephone_number": "818-757-0954",
            "fax_number": "818-757-0963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18518 SHERMAN WAY",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913354212",
            "telephone_number": "818-757-0954",
            "fax_number": "818-757-0963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CISCO MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ CARDENAS",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "FRANCISCO",
        "authorized_official_title_or_position": "PRESIDENT/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "818-757-0954",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0103250",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D1055441",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cisco Medical Group - Reseda",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Primary Care Clinic/Center in Reseda, CA
• Providers in Reseda, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.