NPIMap

Organization Active NPI

Specialty Medical Group Central California - Dept of Medicine

  • Pediatrics Physician
  • Madera, CA
National Provider Identifier
1235310616
Registry record updated Jun 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT OF MEDICINE
Practice address
9300 Valley Childrens PL
MB01
Madera, CA 93636-8761
Phone
(559) 353-6425
Fax
(559) 353-6441
NPI assigned
Nov 14, 2007
Last updated
Jun 28, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2013

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

Authorized official

Name
Devonna M. Kaji, M.D.
Title
President / Medical Director
Phone
(559) 353-5700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X CA Primary

Addresses

Primary practice location

9300 Valley Childrens PL
MB01
Madera, CA 93636-8761

Mailing address

9300 Valley Childrens PL
MB01
Madera, CA 93636-8761
Phone (559) 353-6425

Other identifiers 2

IdentifierTypeStateIssuer
GR0078688MedicaidCA
1013968296OtherCASMG MAIN NPI NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Valley Children's Specialty Medical Group - Pulmonology29 organizations share this tax ID, including this one
Part of
Valley Children's Specialty Medical Group - Pulmonology

Other organizations with this tax ID 28

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

View all 28

Practitioners & affiliated clinicians

Practitioners 2

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": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372377600000",
    "number": "1235310616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9300 VALLEY CHILDRENS PL",
            "address_2": "MB01",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "936368761",
            "telephone_number": "559-353-6425",
            "fax_number": "559-353-6441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 VALLEY CHILDRENS PL",
            "address_2": "MB01",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "936368761",
            "telephone_number": "559-353-6425",
            "fax_number": "559-353-6441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT OF MEDICINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA INC.",
        "enumeration_date": "2007-11-14",
        "last_updated": "2013-06-28",
        "status": "A",
        "authorized_official_last_name": "KAJI",
        "authorized_official_first_name": "DEVONNA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT / MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "559-353-5700",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0078688",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SMG MAIN NPI NUMBER",
            "identifier": "1013968296",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madera, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2013; 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.