Merced Faculty Associates Medical Group Incorporated

Primary specialty

Endoscopy Clinic/CenterTaxonomy code 261QE0800X

Legal business name

MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED

Doing business as

El Portal Endosurgery Center

Practice address

3365 G St
Suite 101
Merced, CA 95340-0994

Phone

(209) 205-1086

Fax

(209) 383-2811

NPI assigned

Jun 30, 2006

Last updated

Jul 21, 2014By 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

Rebecca L Shaw

Title

Ceo

Phone

(209) 723-1920

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• El Portal Endosurgery Center Doing business as

Locations

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405900800000",
    "number": "1174552632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3768",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953443768",
            "telephone_number": "209-725-7149",
            "fax_number": "209-726-0259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3365 G ST",
            "address_2": "SUITE 101",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953400994",
            "telephone_number": "209-205-1086",
            "fax_number": "209-383-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2014-07-21",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-723-1920"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PIN",
            "identifier": "ZZZH2406Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "El Portal Endosurgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Merced County, Behavioral Health and Recovery Services
• Merced Department of Public Health
• Merced Drug
• Merced Emergency Physicians Medical Group, Inc.
• Merced Faculty Associates Medical Group Incorporated (MFA Parkside)
• Merced Faculty Associates Medical Group Incorporated
• Merced Faculty Associates Medical Group Incorporated (Olivewood Meadows Occupational Health Center)
• Merced Faculty Associates Medical Group Incorporated (Yosemite Dialysis Center)
• Merced Faculty Associates Medical Group Incorporated (Fountain View Radiology and Medical Services)
• Merced Faculty Associates Medical Group Incorporated (El Portal Medical Oncology Center)

• Endoscopy Clinic/Center in Merced, CA
• Providers in Merced, CA by specialty
• Endoscopy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; 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.