NPIMap

Individual provider Active NPI

Daniel Borgstadt, M.D.

  • Family Medicine Physician
  • Clovis, CA
National Provider Identifier
1457332330
Registry record updated Mar 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G53110 Issued in CA
Practice address
255 W Herndon Ave # 103
Clovis, CA 93612-0381
Phone
(559) 326-2999
NPI assigned
Nov 8, 2005
Last updated
Mar 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G53110 CA Primary
Obstetrics & Gynecology Physician 207V00000X G53110 CA

Addresses

Primary practice location

255 W Herndon Ave # 103
Clovis, CA 93612-0381

Mailing address

PO Box 28949
Fresno, CA 93729-8949
Phone (559) 228-4200

Other practice location 1

275 W Herndon Ave
Clovis, CA 93612-0204
Phone (559) 324-6200

Other identifiers 4

IdentifierTypeStateIssuer
00G531100MedicaidCA
00G531100OtherCABLUE CROSS/BLUE SHIELD
110121877OtherCARAILROAD MEDICARE
77040368493612B009OtherCACHAMPUS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080628000176 CA Practitioner - Family Practice 9335211895 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oral Roberts University School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

255 W Herndon Ave
Suite 103
Clovis, CA 93612-0381
Phone (559) 326-2999

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53110CAMDPharmacist
G53110CAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dan Borgstadt MD Inc Family Medicine CurrentSince Dec 31, 2021 Accepting new patients
Fresno Community Hospital and Medical Center Past Accepting new patients
Saint Agnes Medical Center Past Accepting new patients
Valley Children's Hospital Past Accepting new patients

Locations

255 W Herndon Ave
Ste 103
Clovis, CA 93612
Phone (559) 326-2999

Interoperability endpoints

  • Direct secure messaging: dborgstadt17629@valleychildrens-prd.direct-ci.com

Organizations & group practices 4

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

Hospital & facility affiliations 5

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": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615852800000",
    "number": "1457332330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28949",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937298949",
            "telephone_number": "559-228-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 W HERNDON AVE # 103",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936120381",
            "telephone_number": "559-326-2999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "275 W Herndon Ave",
            "address_purpose": "LOCATION",
            "city": "Clovis",
            "state": "CA",
            "postal_code": "936120204",
            "country_code": "US",
            "telephone_number": "559-324-6200",
            "fax_number": "559-324-6280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BORGSTADT",
        "first_name": "DANIEL",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G53110",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "G53110",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G531100",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "00G531100",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110121877",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "77040368493612B009",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, CA

Sources for this page

Verify at the official NPI Registry.