NPIMap

Individual provider Active NPI

Michael A Medeiros, M.D.

  • Clinical Neurophysiology Physician
  • Selma, CA
National Provider Identifier
1417120866
Registry record updated Dec 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X
License
64725 Issued in MN
Practice address
2256 Dockery Ave Ste B
Selma, CA 93662-3874
Phone
(559) 856-6170
Fax
(559) 856-6172
NPI assigned
Apr 7, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A117400 CA
Clinical Neurophysiology Physician 2084N0600X 64725 MN Primary

Addresses

Primary practice location

2256 Dockery Ave Ste B
Selma, CA 93662-3874

Mailing address

4032 W Swanson Ave
Caruthers, CA 93609-9552
Phone (559) 856-6170

Other practice location 1

1012 E 2nd St
Duluth, MN 55805-2200
Phone (218) 249-7655

Other practice location 2

1155 Mill St
Reno, NV 89502-1576
Phone (775) 982-7878

Other identifiers 3

IdentifierTypeStateIssuer
12583839OtherCACAQH NUMBER
A117400OtherCALICENSE NUMBER
18511OtherNVLICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NV2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20131105000347 CA Practitioner - Neurology 4688809320 Reassigns benefits to 2 organizations
I20190903001743 NV Practitioner - Neurology 4688809320 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Services LLCGroup PAC ID 1951324318, 630 clinicians
Saint Agnes Medical FoundationGroup PAC ID 7618946369, 161 clinicians
Saint Agnes Medical CenterGroup PAC ID 3971409335, 45 clinicians

Practice addresses (Care Compare)

1155 Mill St
Reno, NV 89502-1576
Phone (775) 982-4000

1221 E Spruce Ave
Fresno, CA 93720-3374
Phone (559) 450-5777

1303 E Herndon Ave
Fresno, CA 93720-3309
Phone (559) 450-3301

1379 E Herndon Ave
Fresno, CA 93720-3309
Phone (559) 450-6388

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.15 of 100Reported as group
Quality
79.09
Promoting interoperability
100
Improvement activities
40
Cost
71.43

Merit-based Incentive Payment System (MIPS)

Final score
85.57 of 100Reported as group
Quality
63.43
Promoting interoperability
98
Improvement activities
40
Cost
77.49

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A117400CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Services LLC Internal Medicine Current Accepting new patients
LQMG Medical Group Inc. Internal Medicine Current Accepting new patients
Community Care Services LLC CurrentSince Aug 1, 2019 Accepting new patients
Trinity Home Health Services CurrentSince Jul 10, 2019 Accepting new patients
Saint Agnes Medical Center CurrentSince Jul 10, 2019 Accepting new patients
Saint Agnes Medical Foundation Internal Medicine CurrentSince Mar 21, 2022 Accepting new patients
Community Care Services LLC CurrentSince Aug 1, 2019 Accepting new patients

Locations

1221 E Spruce Ave
Fresno, CA 93720
Phone (559) 449-5777

1303 E Herndon Ave
Fresno, CA 93720
Phone (559) 449-3000

1495 Mill St
Reno, NV 89502
Phone (775) 982-3500

1155 Mill St
Reno, NV 89502
Phone (775) 982-7878

10315 Professional Cir
Reno, NV 89521
Phone (775) 982-5860

Interoperability endpoints

  • Direct secure messaging: mmederios152922@direct.renown.org
  • Direct secure messaging: mmedeiros2714408@direct.trinity-health.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1207526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576627200000",
    "number": "1417120866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4032 W SWANSON AVE",
            "city": "CARUTHERS",
            "state": "CA",
            "postal_code": "936099552",
            "telephone_number": "559-856-6170",
            "fax_number": "559-856-6172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2256 DOCKERY AVE STE B",
            "city": "SELMA",
            "state": "CA",
            "postal_code": "936623874",
            "telephone_number": "559-856-6170",
            "fax_number": "559-856-6172"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1012 E 2nd St",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558052200",
            "country_code": "US",
            "telephone_number": "218-249-7655",
            "fax_number": "218-249-6989",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1155 Mill St",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895021576",
            "country_code": "US",
            "telephone_number": "775-982-7878",
            "fax_number": "775-982-4196",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDEIROS",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-07",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A117400",
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "MN",
            "license": "64725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH NUMBER",
            "identifier": "12583839",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "A117400",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "18511",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Selma, CA

Sources for this page

Verify at the official NPI Registry.