Meridian Medical Group Professional Corp

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A303360 Issued in CA

Legal business name

MERIDIAN MEDICAL GROUP PROFESSIONAL CORP

Practice address

1047 E Capitol Expy
San Jose, CA 95121-2415

Phone

(408) 754-8988

Fax

(408) 754-8289

NPI assigned

Nov 2, 2006

Last updated

Mar 29, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Albert A Gomez, MDNPI 1134228752

Title

Ceo

Phone

(408) 754-8988

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• MERIDIAN MEDICAL GROUP Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

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.

• Albert A Gomez, M.D.

  • General Practice Physician
  • San Jose, CA
  • NPI 1134228752
  Medicare reassignment Authorized official
• Alfred Coleman Jr., PAC

  • General Practice Physician
  • San Jose, CA
  • NPI 1720171598
  Medicare reassignment

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1457439572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1047 E CAPITOL EXPY",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951212415",
            "telephone_number": "408-754-8988",
            "fax_number": "408-754-8289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1047 E CAPITOL EXPY",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951212415",
            "telephone_number": "408-754-8988",
            "fax_number": "408-754-8289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERIDIAN MEDICAL GROUP PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "408-754-8988",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A303360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "880357380",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0070181",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0070182",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE NUMBER",
            "identifier": "00A303360",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1134228752",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD NUMBER",
            "identifier": "ZZZ41448Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0070180",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERIDIAN MEDICAL GROUP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Lander Merida Gonzales
• Meridian Acupuncture
• Meridian Acupuncture
• Meridian Acupuncture and Herb
• Meridian Dental Associates (Willow Glen Dental Center)
• Meridian Treatment Acupuncture Corp
• Maria Merino
• Max Kai Merrill-Hypko
• Poupak Merrill, PH.D.
• Daniel Steven Merriott, M.D.

• General Practice Physician in San Jose, CA
• Providers in San Jose, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; 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.