NPIMap

Organization Active NPI

Premium Urgent Care, Inc.

Doing business as Premium Urgent Care

  • Urgent Care Clinic/Center
  • Los Banos, CA
National Provider Identifier
1104296888
Registry record updated May 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
PREMIUM URGENT CARE, INC.
Doing business as
Premium Urgent Care
Practice address
1415 Badger Flat Rd
Suite a
Los Banos, CA 93635-8600
Phone
(209) 826-8400
Fax
(209) 710-8763
NPI assigned
Oct 7, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2019

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

Authorized official

Name
Dr. Erick J Green, M.D.NPI 1821371022
Title
Owner
Phone
(559) 797-4315

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
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

1415 Badger Flat Rd
Suite a
Los Banos, CA 93635-8600

Mailing address

2021 Herndon Ave
Suite 101
Clovis, CA 93611-6101
Phone (559) 797-4315

Other identifiers 1

IdentifierTypeStateIssuer
109622OtherCAPREMIUM URGENT CARE GROUP PTAN

Other names 1

  • Premium Urgent Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131223000834 CA Part B Supplier - Clinic/Group Practice 9638306533 Receives reassigned benefits from 11 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clovis, CA; Fresno, CA; Los Banos, CA; Selma, CA

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Premium Urgent Care Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

1415 Badger Flat Rd
Ste A
Los Banos, CA 93635
Phone (209) 710-8684

Practitioners & affiliated clinicians

Practitioners 6

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": "1444176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556755200000",
    "number": "1104296888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 HERNDON AVE",
            "address_2": "SUITE 101",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936116101",
            "telephone_number": "559-797-4315",
            "fax_number": "559-321-8730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 BADGER FLAT RD",
            "address_2": "SUITE A",
            "city": "LOS BANOS",
            "state": "CA",
            "postal_code": "936358600",
            "telephone_number": "209-826-8400",
            "fax_number": "209-710-8763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM URGENT CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-07",
        "last_updated": "2019-05-02",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "ERICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "559-797-4315",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMIUM URGENT CARE GROUP PTAN",
            "identifier": "109622",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premium Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Premium Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Banos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2019; 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.