NPIMap

Organization Active NPI

Fairchild Medical Group

  • Family Medicine Physician
  • Yreka, CA
National Provider Identifier
1063588895
Registry record updated Mar 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAIRCHILD MEDICAL GROUP
Practice address
475 Bruce St Ste 500
Yreka, CA 96097-3463
Phone
(530) 842-3507
NPI assigned
Nov 24, 2006
Last updated
Mar 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2008

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

Authorized official

Name
Steven Maron, MD
Title
President
Phone
(510) 436-9000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

475 Bruce St Ste 500
Yreka, CA 96097-3463

Mailing address

2107 Livingston St
Suite a
Oakland, CA 94606-5218
Phone (510) 436-9000

Other identifiers 3

IdentifierTypeStateIssuer
GR0089870MedicaidCA
ZZZ03208ZOtherCABLUE SHIELD OF CALIFORNIA
RHM53972FMedicaidCA

National Provider Directory

National Provider Directory

Locations

2107 Livingston St
#A
Oakland, CA 94606
Phone (510) 436-9000

475 Bruce St
Ste 500
Yreka, CA 96097
Phone (530) 842-3507

475 Bruce St
Ste 800
Yreka, CA 96097

Practitioners & affiliated clinicians

Practitioners 36

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.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205280000000",
    "number": "1063588895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2107 LIVINGSTON ST",
            "address_2": "SUITE A",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946065218",
            "telephone_number": "510-436-9000",
            "fax_number": "510-436-9013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 BRUCE ST STE 500",
            "city": "YREKA",
            "state": "CA",
            "postal_code": "960973463",
            "telephone_number": "530-842-3507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRCHILD MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-24",
        "last_updated": "2008-03-12",
        "status": "A",
        "authorized_official_last_name": "MARON",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-436-9000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0089870",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "ZZZ03208Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM53972F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yreka, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; 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.