San Joaquin Prime Care Medical Group Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A43893 Issued in CA

Legal business name

SAN JOAQUIN PRIME CARE MEDICAL GROUP INC

Practice address

330 E Pine St
Exeter, CA 93221-1838

Phone

(559) 592-2134

Fax

(559) 592-5017

NPI assigned

Jan 5, 2007

Last updated

Apr 24, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rita Nye

Title

Billing Supervisor

Phone

(559) 783-1181

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429833600000",
    "number": "1265580500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 E PINE ST",
            "city": "EXETER",
            "state": "CA",
            "postal_code": "932211838",
            "telephone_number": "559-592-2134",
            "fax_number": "559-592-5017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 E PINE ST",
            "city": "EXETER",
            "state": "CA",
            "postal_code": "932211838",
            "telephone_number": "559-592-2134",
            "fax_number": "559-592-5017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOAQUIN PRIME CARE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2015-04-24",
        "status": "A",
        "authorized_official_last_name": "NYE",
        "authorized_official_first_name": "RITA",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "559-783-1181"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A43893",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0084780",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM53822F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Ropes
• Albert D. Rosales Jr., MHRS
• Joanne Rubalcaba
• Rose Rubio
• Maria Isabel Salazar
• Sheila Scheinesson, PA-C
• Stanton Schuler, DDS
• Joanne Lee Scott, LVN
• Raymond Michael Scott, CADTP
• Joshua Seaman

• Family Medicine Physician in Exeter, CA
• Providers in Exeter, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2015; 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.