NPIMap

Organization Active NPI

Gettysburg Medical Clinic Inc

  • Primary Care Clinic/Center
  • Atwater, CA
National Provider Identifier
1174989594
Registry record updated Jan 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
A26653 Issued in CA
Legal business name
GETTYSBURG MEDICAL CLINIC INC
Practice address
1834 Bellevue Rd
Atwater, CA 95301-2670
Phone
(209) 285-9688
Fax
(209) 725-2072
NPI assigned
Jan 14, 2016
Last updated
Jan 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2016

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

Authorized official

Name
Dr. Johnny Yee Fong, M.D.
Title
Medical Director
Phone
(559) 259-1982

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X A26653 CA Primary

Addresses

Primary practice location

1834 Bellevue Rd
Atwater, CA 95301-2670

Mailing address

1834 Bellevue Rd
Atwater, CA 95301-2670
Phone (209) 285-9688

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121128000353 CA Part B Supplier - Clinic/Group Practice 5991957805 Receives reassigned benefits from 5 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Modesto, CA; Merced, CA; Fresno, CA; Atwater, CA

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
All American Medical Orthopedic Clinics Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

1834 Bellevue Rd
Atwater, CA 95301
Phone (209) 285-9688

143 W Main St
Merced, CA 95340
Phone (209) 725-2060

1130 Coffee Rd
Ste 10
Modesto, CA 95355
Phone (209) 312-9865

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1452729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452729600000",
    "number": "1174989594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1834 BELLEVUE RD",
            "city": "ATWATER",
            "state": "CA",
            "postal_code": "953012670",
            "telephone_number": "209-285-9688",
            "fax_number": "209-725-2072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1834 BELLEVUE RD",
            "city": "ATWATER",
            "state": "CA",
            "postal_code": "953012670",
            "telephone_number": "209-285-9688",
            "fax_number": "209-725-2072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GETTYSBURG MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-14",
        "last_updated": "2016-01-14",
        "status": "A",
        "authorized_official_last_name": "FONG",
        "authorized_official_first_name": "JOHNNY",
        "authorized_official_middle_name": "YEE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "559-259-1982",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A26653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atwater, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2016; 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.