Individual provider Active NPI

Judy Miramontes, M.D.

  • Family Medicine Physician
  • Clovis, CA
National Provider Identifier
1477534345
Registry record updated Feb 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G80495 Issued in CA
Practice address
275 W Herndon Ave
Clovis, CA 93612-0204
Phone
(559) 324-6200
Fax
(559) 324-6280
NPI assigned
Nov 8, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2020

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 G80495 CA Primary
Obstetrics & Gynecology Physician 207V00000X G80495 CA

Addresses

Primary practice location

275 W Herndon Ave
Clovis, CA 93612-0204

Mailing address

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

Other identifiers 4

IdentifierTypeStateIssuer
080085527OtherCARAILROAD MEDICARE
00G804950OtherCABLUE CROSS/BLUE SHIELD
00G804950MedicaidCA
77040368493612B012OtherCACHAMPUS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080618000357 CA Practitioner - Family Practice 4183795123 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Foundation Medical GroupGroup PAC ID 0345406294, 282 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

  • Clovis Community Medical Center Hospital, Clovis, CA, CCN 050492
  • Community Regional Medical Center Hospital, Fresno, CA, CCN 050060

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G80495CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Foundation Medical Group CurrentSince Apr 1, 2014 Accepting new patients
Community Foundation Medical Group Current Accepting new patients
Community Foundation Medical Group Family Medicine CurrentSince Apr 1, 2014 Accepting new patients
Fresno Community Hospital and Medical Center Past Accepting new patients
Valley Children'S Hospital Past Accepting new patients

Locations

275 W Herndon Ave
Clovis, CA 93612
Phone (559) 321-4255

2335 E Kashian Ln
Ste 270
Fresno, CA 93701
Phone (559) 445-1251

Organizations & group practices 5

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 2

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": "1582588800000",
    "number": "1477534345",
    "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",
            "fax_number": "559-224-3920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 W HERNDON AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936120204",
            "telephone_number": "559-324-6200",
            "fax_number": "559-324-6280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRAMONTES",
        "first_name": "JUDY",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-08",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G80495",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "G80495",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080085527",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "00G804950",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G804950",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "77040368493612B012",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, CA

Sources for this page

Verify at the official NPI Registry.