NPIMap

Organization Active NPI

Amador Anesthesia Medical Group, Inc.

  • Anesthesiology Physician
  • Jackson, CA
National Provider Identifier
1255398343
Registry record updated Jun 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
AMADOR ANESTHESIA MEDICAL GROUP, INC.
Practice address
200 Mission Blvd
Jackson, CA 95642
Phone
(209) 223-7500
NPI assigned
May 1, 2006
Last updated
Jun 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2022

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

Authorized official

Name
Grant Hasson, MDNPI 1588621676
Title
Group President
Phone
(209) 223-7500

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
Anesthesiology Physician 207L00000X Primary

Addresses

Primary practice location

200 Mission Blvd
Jackson, CA 95642

Mailing address

PO Box 7096
Stockton, CA 95267-0096
Phone (209) 956-7725

Other identifiers 4

IdentifierTypeStateIssuer
DC9710OtherCARAILROAD MEDICARE
GR0099110MedicaidCA
607575600OtherCAUS DEPT OF LABOR
ZZZ644662OtherCABLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050404000288 CA Part B Supplier - Clinic/Group Practice 6305893223 Receives reassigned benefits from 9 practitioners
Practice locations: Jackson, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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": "1146441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655683200000",
    "number": "1255398343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7096",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952670096",
            "telephone_number": "209-956-7725",
            "fax_number": "209-956-7733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MISSION BLVD",
            "city": "JACKSON",
            "state": "CA",
            "postal_code": "95642",
            "telephone_number": "209-223-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMADOR ANESTHESIA MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-01",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A",
        "authorized_official_last_name": "HASSON",
        "authorized_official_first_name": "GRANT",
        "authorized_official_title_or_position": "GROUP PRESIDENT",
        "authorized_official_telephone_number": "209-223-7500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC9710",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0099110",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "607575600",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ644662",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; 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.