Individual provider Active NPI

Greg Mellor, PA

  • Physician Assistant
  • Fresno, CA
National Provider Identifier
1487637468
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA16213 Issued in CA
Practice address
1630 E Herndon Ave
Fresno, CA 93720-3305
Phone
(559) 256-5200
Fax
(559) 256-5376
NPI assigned
Nov 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA16213 CA Primary

Addresses

Primary practice location

1630 E Herndon Ave
Fresno, CA 93720-3305

Mailing address

1630 E Herndon Ave
Fresno, CA 93720-3305
Phone (559) 256-5200

Other identifiers 1

IdentifierTypeStateIssuer
0170215OtherCASTATE OF WASHINGTON

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090715000077 CA Practitioner - Physician Assistant 0042362576 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of California, Davis School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1235 W Vine St
Suite 22
Lodi, CA 95240-5144
Phone (209) 334-8520

729 Pauline Court
Sonora, CA 95370
Phone (209) 588-8068

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.77 of 100Reported as apm
Quality
81.54
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA16213CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Physicians Network CurrentSince Oct 1, 2023 Accepting new patients
Adventist Health Physicians Network CurrentSince Oct 1, 2023 Accepting new patients
Sierra Pacific Orthopaedic Center Medical Group, Inc. CurrentSince Sep 1, 2008 Accepting new patients

Locations

1630 E Herndon Ave
Fresno, CA 93720
Phone (559) 256-5200

Interoperability endpoints

  • Direct secure messaging: greg.mellor.p1@direct.spocortho.nextgenshare.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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1132704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487637468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 E HERNDON AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203305",
            "telephone_number": "559-256-5200",
            "fax_number": "559-256-5376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 E HERNDON AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203305",
            "telephone_number": "559-256-5200",
            "fax_number": "559-256-5376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLOR",
        "first_name": "GREG",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA16213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF WASHINGTON",
            "identifier": "0170215",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.