NPIMap

Organization Active NPI

Clovis Community Medical Center

  • General Acute Care Hospital
  • Clovis, CA
National Provider Identifier
1235303306
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
040000004 Issued in CA
Legal business name
CLOVIS COMMUNITY MEDICAL CENTER
Practice address
2755 Herndon Ave
Clovis, CA 93611-6800
Phone
(559) 459-1672
Fax
(559) 459-1058
NPI assigned
Apr 18, 2008
Last updated
Jun 24, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

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

Authorized official

Name
Mr. Craig Allen Wagoner
Title
Ceo
Phone
(559) 324-4266

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 040000004 CA Primary

Addresses

Primary practice location

2755 Herndon Ave
Clovis, CA 93611-6800

Mailing address

2755 Herndon Ave
Clovis, CA 93611-6800
Phone (559) 459-1672

Other names 1

  • Clovis Community EKG Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050531000251 CA Part B Supplier - Clinic/Group Practice 3173430865 Receives reassigned benefits from 122 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clovis, CA; Fresno, CA

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory
Tax ID family
Fresno Community Hospit22 organizations share this tax ID, including this one
Part of
Fresno Community Hospit

Other organizations with this tax ID 21

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

View all 21

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750723200000",
    "number": "1235303306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2755 HERNDON AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936116800",
            "telephone_number": "559-459-1672",
            "fax_number": "559-459-1058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2755 HERNDON AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936116800",
            "telephone_number": "559-459-1672",
            "fax_number": "559-459-1058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOVIS COMMUNITY MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER",
        "enumeration_date": "2008-04-18",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A",
        "authorized_official_last_name": "WAGONER",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "559-324-4266",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "040000004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clovis Community EKG",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Clovis Community EKG",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Clovis, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2025; 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.