Prestige Med Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A80856 Issued in CA

Legal business name

PRESTIGE MED INC

Practice address

11030 Bollinger Canyon Rd
Ste 240
San Ramon, CA 94582-4874

Phone

(925) 718-6622

Fax

(201) 690-8632

NPI assigned

May 21, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Joseph Y Mardanzai, MDNPI 1043220031

Title

Owner

Phone

(925) 718-6622

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Prestige Med Inc

  • Internal Medicine Physician
  • San Ramon, CA
  • NPI 1477968741

  O20120702000130

  Same enrollment

Tax ID family

Prestige Med Inc2 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.

• Prestige Med Inc

  • Internal Medicine Physician
  • San Ramon, CA
  • NPI 1477968741
  NPD tax ID

Practitioners 1

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

• Joseph Yusaf Mardanzai, MD

  • Internal Medicine Physician
  • San Ramon, CA
  • NPI 1043220031
  NPD Authorized official

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

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447286400000",
    "number": "1447510789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3888",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945838888",
            "telephone_number": "925-718-6622",
            "fax_number": "201-690-8632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11030 BOLLINGER CANYON RD",
            "address_2": "STE 240",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945824874",
            "telephone_number": "925-718-6622",
            "fax_number": "201-690-8632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE MED INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-21",
        "last_updated": "2015-11-12",
        "status": "A",
        "authorized_official_last_name": "MARDANZAI",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "925-718-6622",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A80856",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "A80856",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "GF086A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Prestige Med Inc
• Jason Lagmay Prestosa, PT, DPT
• Lareza M Prestosa
• Shane Price, RBT
• Tayler Prince

• Internal Medicine Physician in San Ramon, CA
• Providers in San Ramon, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2015; 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.