NPIMap

Organization Active NPI

Cardiac Institute of Central California a Medical Corporation

  • Cardiovascular Disease Physician
  • Fresno, CA
National Provider Identifier
1255341814
Registry record updated Mar 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
CARDIAC INSTITUTE OF CENTRAL CALIFORNIA A MEDICAL CORPORATION
Practice address
30 River Park Place W
440
Fresno, CA 93720
Phone
(559) 256-5500
Fax
(559) 256-5505
NPI assigned
Aug 8, 2006
Last updated
Mar 14, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2013

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

Authorized official

Name
Sam A Borno, MDNPI 1598758468
Title
Owner/President
Phone
(559) 256-5500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary

Addresses

Primary practice location

30 River Park Place W
440
Fresno, CA 93720

Mailing address

30 River Park Place W
440
Fresno, CA 93720
Phone (559) 256-5500

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ29724ZOtherMEDICARE PTAN
GR0098720MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040723001082 CA Part B Supplier - Clinic/Group Practice 4284698333 Receives reassigned benefits from 2 practitioners
Practice locations: Fresno, CA

National Provider Directory

National Provider Directory

Locations

30 E River Park Pl W
#440E
Fresno, CA 93720

30 E River Park Pl W
Ste 440
Fresno, CA 93720
Phone (559) 256-5500

Practitioners & affiliated clinicians

Practitioners 4

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": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363219200000",
    "number": "1255341814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 RIVER PARK PLACE W",
            "address_2": "440",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "93720",
            "telephone_number": "559-256-5500",
            "fax_number": "559-256-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 RIVER PARK PLACE W",
            "address_2": "440",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "93720",
            "telephone_number": "559-256-5500",
            "fax_number": "559-256-5505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDIAC INSTITUTE OF CENTRAL CALIFORNIA A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2013-03-14",
        "status": "A",
        "authorized_official_last_name": "BORNO",
        "authorized_official_first_name": "SAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "559-256-5500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "ZZZ29724Z",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0098720",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2013; 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.