NPIMap

Organization Active NPI

Merced Faculty Associates Medical Group Incorporated

  • Family Medicine Physician
  • Merced, CA
National Provider Identifier
1457550089
Registry record updated Sep 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED
Practice address
374 W Olive Ave
Suite a
Merced, CA 95348-3181
Phone
(209) 205-1001
Fax
(209) 205-1004
NPI assigned
Jul 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2012

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

Authorized official

Name
Rebecca Shaw
Title
Ceo
Phone
(209) 723-1920

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

374 W Olive Ave
Suite a
Merced, CA 95348-3181

Mailing address

PO Box 3768
Merced, CA 95344-3768
Phone (209) 725-7149

Other identifiers 3

IdentifierTypeStateIssuer
CS1342OtherGARAILROAD MEDICARE
ZZZ50049YOtherCABLUE SHIELD GROUP
GR0041483MedicaidCAMEDI-CAL GROUP NUMBER

Other names 1

  • Olivewood Meadows Occupational Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040409000199 CA Part B Supplier - Clinic/Group Practice 4789678111 Receives reassigned benefits from 49 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Atwater, CA; Merced, CA; Livingston, CA; Hilmar, CA; Delhi, CA

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Merced Faculty Associates Medical Group Incorporated10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

NPI Registry JSON

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

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348790400000",
    "number": "1457550089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3768",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953443768",
            "telephone_number": "209-725-7149",
            "fax_number": "209-726-0259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374 W OLIVE AVE",
            "address_2": "SUITE A",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953483181",
            "telephone_number": "209-205-1001",
            "fax_number": "209-205-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-13",
        "last_updated": "2012-09-28",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-723-1920"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CS1342",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP",
            "identifier": "ZZZ50049Y",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": "MEDI-CAL GROUP NUMBER",
            "identifier": "GR0041483",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olivewood Meadows Occupational Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Merced, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; 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.