NPIMap

Organization Active NPI

County of Fresno

  • State or Local Public Health Clinic/Center
  • Fresno, CA
National Provider Identifier
1093898348
Registry record updated Oct 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X
Legal business name
COUNTY OF FRESNO
Practice address
1221 Fulton Mall
Immunization Clinic,1St Floor
Fresno, CA 93721-1915
Phone
(559) 600-3281
Fax
(559) 600-7726
NPI assigned
Oct 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2014

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

Authorized official

Name
Mr. David Pomaville, M.B.A., R.E.H.S.
Title
Director
Phone
(559) 600-3200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
State or Local Public Health Clinic/Center 261QP0905X CA Primary

Addresses

Primary practice location

1221 Fulton Mall
Immunization Clinic,1St Floor
Fresno, CA 93721-1915

Mailing address

PO Box 11800
6TH Floor
Fresno, CA 93775-1800
Phone (559) 600-6415

Other identifiers 4

IdentifierTypeStateIssuer
CF418AOtherCAMEDICARE
341OtherCACHDP BLUE CROSS
351OtherCACHDP HEALTH NET
CH086OtherCACHDP

Other names 1

  • Department of Public Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090930000219 CA Part B Supplier - Mass Immunization (Roster Biller Only) 4981591690 Receives reassigned benefits from 1 practitioner
Practice locations: Fresno, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

  • County of Fresno
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Fresno, CA
    • NPI 1770538001

    4981591690

    Same PAC ID

National Provider Directory

National Provider Directory
Tax ID family
Sierra Foothills HLTH C115 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

Locations

1221 Fulton St
Fl 1
Fresno, CA 93721
Phone (559) 445-3550

Practitioners & affiliated clinicians

Practitioners 1

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": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414368000000",
    "number": "1093898348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11800",
            "address_2": "6TH FLOOR",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937751800",
            "telephone_number": "559-600-6415",
            "fax_number": "559-600-7692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 FULTON MALL",
            "address_2": "IMMUNIZATION CLINIC,1ST FLOOR",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211915",
            "telephone_number": "559-600-3281",
            "fax_number": "559-600-7726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF FRESNO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2014-10-27",
        "status": "A",
        "authorized_official_last_name": "POMAVILLE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "559-600-3200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.B.A., R.E.H.S."
    },
    "taxonomies": [
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "CF418A",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHDP BLUE CROSS",
            "identifier": "341",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHDP HEALTH NET",
            "identifier": "351",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHDP",
            "identifier": "CH086",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Department of Public Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.