NPIMap

Organization Active NPI

Internal Medicine Specialists Medical Group, Inc.

  • Internal Medicine Physician
  • Fresno, CA
National Provider Identifier
1366783268
Registry record updated Jun 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G59244 Issued in CA
Legal business name
INTERNAL MEDICINE SPECIALISTS MEDICAL GROUP, INC.
Practice address
1515 E Alluvial Ave
Suite 101
Fresno, CA 93720-3832
Phone
(559) 435-0339
Fax
(559) 435-0853
NPI assigned
Mar 3, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2023

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

Authorized official

Name
Dr. Mythe Laramie, MDNPI 1801907399
Title
Co-Owner
Phone
(559) 435-0339

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X G59244 CA Primary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X G38222 CA

Addresses

Primary practice location

1515 E Alluvial Ave
Suite 101
Fresno, CA 93720-3832

Mailing address

1515 E Alluvial Ave
Suite 101
Fresno, CA 93720-3832
Phone (559) 435-0339

Other identifiers 1

IdentifierTypeStateIssuer
G80217OtherCAINTERNAL MEDICINE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130529000130 CA Part B Supplier - Clinic/Group Practice 5092953323 Receives reassigned benefits from 3 practitioners
Practice locations: Fresno, CA

National Provider Directory

National Provider Directory

Locations

1515 E Alluvial Ave
#101
Fresno, CA 93720
Phone (559) 299-1515

Practitioners & affiliated clinicians

Practitioners 4

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": "1362268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686009600000",
    "number": "1366783268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E ALLUVIAL AVE",
            "address_2": "SUITE 101",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203832",
            "telephone_number": "559-435-0339",
            "fax_number": "559-435-0853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 E ALLUVIAL AVE",
            "address_2": "SUITE 101",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203832",
            "telephone_number": "559-435-0339",
            "fax_number": "559-435-0853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE SPECIALISTS MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-03",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A",
        "authorized_official_last_name": "LARAMIE",
        "authorized_official_first_name": "MYTHE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "559-435-0339",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G59244",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G38222",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNAL MEDICINE",
            "identifier": "G80217",
            "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 Jun 6, 2023; 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.