NPIMap

Organization Active NPI

Choice Medical Clinic, Inc.

Doing business as Choice Medical Group

  • Specialist
  • San Jose, CA
National Provider Identifier
1174711915
Registry record updated Nov 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
CHOICE MEDICAL CLINIC, INC.
Doing business as
Choice Medical Group
Practice address
1834 Stone Ave
Suite 2B
San Jose, CA 95125-1306
Phone
(408) 995-0102
Fax
(408) 995-6842
NPI assigned
Oct 5, 2007
Last updated
Nov 27, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2007

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

Authorized official

Name
Dr. Norman Fisk, M.D.
Title
Owner
Phone
(408) 995-0102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

1834 Stone Ave
Suite 2B
San Jose, CA 95125-1306

Mailing address

PO Box 5640
San Jose, CA 95150-5640
Phone (408) 995-0102

Other identifiers 1

IdentifierTypeStateIssuer
GR0006542MedicaidCA

Other names 1

  • Choice Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Choice Medical Clinic Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1834 Stone Ave
Ste 2B
San Jose, CA 95125
Phone (408) 995-0102

NPI Registry JSON

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196121600000",
    "number": "1174711915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5640",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951505640",
            "telephone_number": "408-995-0102",
            "fax_number": "408-995-6842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1834 STONE AVE",
            "address_2": "SUITE 2B",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951251306",
            "telephone_number": "408-995-0102",
            "fax_number": "408-995-6842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHOICE MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-05",
        "last_updated": "2007-11-27",
        "status": "A",
        "authorized_official_last_name": "FISK",
        "authorized_official_first_name": "NORMAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "408-995-0102",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0006542",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Choice Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; 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.