Cisco Medical Group, Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

CISCO MEDICAL GROUP, INC

Practice address

290 E Verdugo Ave Ste 206
Burbank, CA 91502-1342

Phone

(818) 757-0954

Fax

(818) 757-0963

NPI assigned

May 20, 2021

Organization subpart

No

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

Authorized official

Name

Jose Francisco Martinez Cardenas, MD

Title

President/Medical Director

Phone

(818) 757-0954

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Cisco Medical Group - Burbank Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Cisco Medical Group, Inc

  • Primary Care Clinic/Center
  • Reseda, CA
  • NPI 1053408989

  O20050614000315

  Same enrollment

Tax ID family

Cisco Medical Group - Burbank2 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.

• Cisco Medical Group, Inc

  • Primary Care Clinic/Center
  • Reseda, CA
  • NPI 1053408989
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carmen Cortez Ortega

  • Physician Assistant
  • Reseda, CA
  • NPI 1558911602
  NPD
• Poorvi P Shah, D.O.

  • Family Medicine Physician
  • Bloomfield Hills, MI
  • NPI 1306918073
  NPD (past)

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

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1164097341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18518 SHERMAN WAY",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913354212",
            "telephone_number": "818-757-0954",
            "fax_number": "818-757-0963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 E VERDUGO AVE STE 206",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915021342",
            "telephone_number": "818-757-0954",
            "fax_number": "818-757-0963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CISCO MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-20",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ CARDENAS",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "FRANCISCO",
        "authorized_official_title_or_position": "PRESIDENT/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "818-757-0954",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D1013422",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cisco Medical Group - Burbank",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cisco Medical Group - Burbank",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Augustine Chung, M.D.
• Kevin Chung
• Jody Churko
• Cipher Home Health
• Cipher Hospice
• Trinity Cislo
• Mayra Cisneros Vazquez
• City of Burbank
• Citywide Hospice Care, Inc
• Cathryn Clabaugh

• Primary Care Clinic/Center in Burbank, CA
• Providers in Burbank, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.