Individual provider Active NPI

Peter John Georgio II, M.D.

  • Family Medicine Physician
  • Fresno, CA
National Provider Identifier
1053574947
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A104803 Issued in CA
Practice address
2263 W Birch Ave
Fresno, CA 93711-0442
Phone
(559) 431-8515
NPI assigned
Jul 9, 2008
Last updated
May 9, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A104803 CA Primary

Addresses

Primary practice location

2263 W Birch Ave
Fresno, CA 93711-0442

Mailing address

155 N Fresno St
Fresno, CA 93701-2302
Phone (559) 499-6450

Other practice location 1

1444 E Holt Ave
Pomona, CA 91767-5865
Phone (310) 957-5524

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pgeorgio196684@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100604000669 CA Practitioner - Family PracticePractitioner - Sports Medicine 0244360063 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Usc Care Medical Group IncGroup PAC ID 0446157747, shared by 9 NPIs, 1,378 clinicians
Beach Cities Orthopedics and Sports MedicineGroup PAC ID 7517014251, 33 clinicians

Practice addresses (Care Compare)

1520 San Pablo St
Los Angeles, CA 90033-5310
Phone (800) 872-2273

1520 San Pablo St 1St Floor N
Los Angeles, CA 90033-5310
Phone (800) 872-2273

400 S Sepulveda Blvd
Suite 200
Manhattan Beach, CA 90266-6876
Phone (310) 546-3461

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A104803CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Facey Medical Foundation Family Medicine Current Accepting new patients
Providence Facey Medical Foundation CurrentSince Sep 3, 2020 Accepting new patients
Providence Facey Medical Foundation CurrentSince Sep 3, 2020 Accepting new patients
Little Company of Mary Affiliated Services Inc Past Accepting new patients
Exer Medical Corporation PastSince Nov 10, 2014 Accepting new patients
Cedars-Sinai Marina Hospital Past Accepting new patients

Locations

4143 Campus Dr
Ste C200
Irvine, CA 92612
Phone (949) 471-0002

File 50670
Los Angeles, CA 90074

19950 Rinaldi St
Ste 103
Porter Ranch, CA 91326
Phone (818) 403-2400

701 N Wendy Dr
Thousand Oaks, CA 91320
Phone (805) 375-4400

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1053574947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 N FRESNO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937012302",
            "telephone_number": "559-499-6450",
            "fax_number": "559-499-6451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2263 W BIRCH AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937110442",
            "telephone_number": "559-431-8515"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1444 E Holt Ave",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917675865",
            "country_code": "US",
            "telephone_number": "310-957-5524",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GEORGIO",
        "first_name": "PETER",
        "middle_name": "JOHN",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-09",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A104803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pgeorgio196684@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "400 S Sepulveda Blvd Ste 200",
            "city": "Manhattan Beach",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902666876",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.