Organization Active NPI

Premier Emergency Physicians of California Medical Group PC

  • Emergency Medicine Physician
  • Gridley, CA
National Provider Identifier
1174572945
Registry record updated Apr 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
PREMIER EMERGENCY PHYSICIANS OF CALIFORNIA MEDICAL GROUP PC
Practice address
240 Spruce St
Gridley, CA 95948-2216
Phone
(530) 846-9021
NPI assigned
May 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2021

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

Authorized official

Name
Kathy Kondas
Title
Officer
Phone
(943) 251-1132

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

240 Spruce St
Gridley, CA 95948-2216

Mailing address

5565 Centerview Dr Ste 107
Raleigh, NC 27606-3563

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ65982ZOtherCABLUE SHIELD
GR0094160MedicaidCA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617926400000",
    "number": "1174572945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5565 CENTERVIEW DR STE 107",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276063563",
            "fax_number": "214-712-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 SPRUCE ST",
            "city": "GRIDLEY",
            "state": "CA",
            "postal_code": "959482216",
            "telephone_number": "530-846-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER EMERGENCY PHYSICIANS OF CALIFORNIA MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A",
        "authorized_official_last_name": "KONDAS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "943-251-1132"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ65982Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0094160",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gridley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; 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.