Organization Active NPI

Michael D. McGavic DPM, a Professional Corporation

  • Podiatrist
  • Norwalk, CA
National Provider Identifier
1144548439
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
E4048 Issued in CA
Legal business name
MICHAEL D. MCGAVIC DPM, A PROFESSIONAL CORPORATION
Practice address
13132 Studebaker Rd
Suite 2
Norwalk, CA 90650-2557
Phone
(562) 651-1111
Fax
(562) 651-1131
NPI assigned
May 11, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

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

Authorized official

Name
Dr. Michael Darin McGavicNPI 1033137427
Title
Doctor/President
Phone
(562) 651-1111

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
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X E4048 CA Primary

Addresses

Primary practice location

13132 Studebaker Rd
Suite 2
Norwalk, CA 90650-2557

Mailing address

13132 Studebaker Rd
Suite 2
Norwalk, CA 90650-2557
Phone (562) 651-1111

Other identifiers 1

IdentifierTypeStateIssuer
000E40480OtherCAMEDICARE ID

Other names 1

  • Michael D. McGavic, A Professional Corporation Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100127000128 CA Part B Supplier - Clinic/Group Practice 1153463351 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Norwalk, CA; Stockton, CA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Michael D McGavic Apc2 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.

Locations

1755 W Hammer Ln
Stockton, CA 95209
Phone (209) 444-8910

1755 W Hammer Ln
#S7B
Stockton, CA 95209

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": "1273536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732060800000",
    "number": "1144548439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13132 STUDEBAKER RD",
            "address_2": "SUITE 2",
            "city": "NORWALK",
            "state": "CA",
            "postal_code": "906502557",
            "telephone_number": "562-651-1111",
            "fax_number": "562-651-1131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13132 STUDEBAKER RD",
            "address_2": "SUITE 2",
            "city": "NORWALK",
            "state": "CA",
            "postal_code": "906502557",
            "telephone_number": "562-651-1111",
            "fax_number": "562-651-1131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL D. MCGAVIC DPM, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-11",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A",
        "authorized_official_last_name": "MCGAVIC",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DARIN",
        "authorized_official_title_or_position": "DOCTOR/PRESIDENT",
        "authorized_official_telephone_number": "562-651-1111",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E4048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "000E40480",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michael D. McGavic, A Professional Corporation",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Michael D. McGavic, A Professional Corporation",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Norwalk, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; 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.