Executive Medical & Surgical Associates Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

A72267 Issued in CA

Legal business name

EXECUTIVE MEDICAL & SURGICAL ASSOCIATES INC.

Doing business as

Bergey Spine Institute

Practice address

900 E Washington St Ste 300
Colton, CA 92324-8182

Phone

(909) 824-2422

Fax

(909) 824-8234

NPI assigned

Aug 22, 2016

Last updated

Aug 22, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cheryl Dalene Bergey, RN

Title

Office Manager

Phone

(909) 824-2422

Specialties & licenses 4

Addresses

Other names 1

• Bergey Spine Institute Doing business as

Tax ID family

Bergey Spine Institute2 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.

• Executive Medical & Surgical Assoc. Inc.

  • Specialist
  • Colton, CA
  • NPI 1609887322
  NPD tax ID

Locations

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

{
    "created_epoch": "1471824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471824000000",
    "number": "1144775016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81880 DOCTOR CARREON BLVD STE C212",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922015519",
            "telephone_number": "760-775-9400",
            "fax_number": "760-775-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 E WASHINGTON ST STE 300",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923248182",
            "telephone_number": "909-824-2422",
            "fax_number": "909-824-8234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE MEDICAL & SURGICAL ASSOCIATES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-22",
        "last_updated": "2016-08-22",
        "status": "A",
        "authorized_official_last_name": "BERGEY",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "DALENE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "909-824-2422",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA21389",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA 52156",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A89036",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A72267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bergey Spine Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sara Elizabeth Cherry Evans, M.S.
• Matthew Ewell
• Kathleen Ewing
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• Executive Medical & Surgical Assoc. Inc.
• Executive Medical & Surgical Associates Inc.
• Julie O Eze
• Czarina Irish Facer, M.S., CCC-SLP
• Faculty Medical Group of Llusm (Faculty Medical Group of Llusm-Radiology)
• Faculty Physicians and Surgeons of Llusm

• Specialist in Colton, CA
• Providers in Colton, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2016; 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.