NPIMap

Organization Active NPI

Fortuna Medical Group

  • Clinic/Center
  • Yuma, AZ
National Provider Identifier
1386044477
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
FORTUNA MEDICAL GROUP
Practice address
11510 S Fortuna Rd
Suite a
Yuma, AZ 85367-7843
Phone
(928) 342-7046
Fax
(928) 342-7018
NPI assigned
Aug 26, 2014
Last updated
Sep 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Authorized official

Name
Oswald Lopez
Title
Manager
Phone
(928) 342-7046

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

11510 S Fortuna Rd
Suite a
Yuma, AZ 85367-7843

Mailing address

11510 S Fortuna Rd
Ste a
Yuma, AZ 85367-7843
Phone (928) 342-7046

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160519001610 AZ Part B Supplier - Clinic/Group Practice 2264721968 Receives reassigned benefits from 3 practitioners
Practice locations: Yuma, AZ

National Provider Directory

National Provider Directory
Tax ID family
Fortuna Medical Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

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": "1409011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695859200000",
    "number": "1386044477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11510 S FORTUNA RD",
            "address_2": "STE A",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853677843",
            "telephone_number": "928-342-7046",
            "fax_number": "928-342-7018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11510 S FORTUNA RD",
            "address_2": "SUITE A",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853677843",
            "telephone_number": "928-342-7046",
            "fax_number": "928-342-7018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORTUNA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-26",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "OSWALD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "928-342-7046"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yuma, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.