NPIMap

Organization Active NPI

Emanuel Medical Group, Inc.

  • Family Medicine Physician
  • Turlock, CA
National Provider Identifier
1275764615
Registry record updated Oct 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2854800000 Issued in CA
Legal business name
EMANUEL MEDICAL GROUP, INC.
Practice address
2121 Colorado Ave
Suite C
Turlock, CA 95382-2012
Phone
(209) 664-5175
Fax
(209) 669-4684
NPI assigned
Aug 3, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2013

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

Authorized official

Name
Dr. Thomas Kirk Johnson, M.D.
Title
President/Ceo
Phone
(209) 664-5150

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 2854800000 CA Primary

Addresses

Primary practice location

2121 Colorado Ave
Suite C
Turlock, CA 95382-2012

Mailing address

2121 Colorado Ave
Suite C
Turlock, CA 95382-2012
Phone (209) 664-5175

Other identifiers 1

IdentifierTypeStateIssuer
1275764615MedicaidCA

Other names 1

  • Emmanuel Medical Group Other name

National Provider Directory

National Provider Directory

Locations

2121 Colorado Ave
Ste C
Turlock, CA 95382
Phone (209) 644-5175

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1249257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381881600000",
    "number": "1275764615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 COLORADO AVE",
            "address_2": "SUITE C",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953822012",
            "telephone_number": "209-664-5175",
            "fax_number": "209-669-4684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 COLORADO AVE",
            "address_2": "SUITE C",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953822012",
            "telephone_number": "209-664-5175",
            "fax_number": "209-669-4684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMANUEL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-03",
        "last_updated": "2013-10-16",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "KIRK",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "209-664-5150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "2854800000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275764615",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emmanuel Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Turlock, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.