San Joaquin Prime Care Medical Group Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A43893 Issued in CA

Legal business name

SAN JOAQUIN PRIME CARE MEDICAL GROUP INC

Practice address

682 E Visalia Rd
Farmersville, CA 93223-1641

Phone

(559) 594-4564

Fax

(559) 594-4564

NPI assigned

Sep 5, 2007

Organization subpart

No

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

Authorized official

Name

Kim Burgins

Title

Billing Supervisor

Phone

(559) 783-1181

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430092800000",
    "number": "1487848131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 E PINE ST",
            "city": "EXETER",
            "state": "CA",
            "postal_code": "932211838",
            "telephone_number": "559-592-2134",
            "fax_number": "559-592-5017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "682 E VISALIA RD",
            "city": "FARMERSVILLE",
            "state": "CA",
            "postal_code": "932231641",
            "telephone_number": "559-594-4564",
            "fax_number": "559-594-4564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOAQUIN PRIME CARE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2015-04-27",
        "status": "A",
        "authorized_official_last_name": "BURGINS",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "559-783-1181"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A43893",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM53939F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0084781",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luis Rivera
• Guadalupe Rodarte
• Angelica Rogers, NURSE
• Mercedes Rosales
• Feby Salem
• Beatriz Sanchez, PPS
• Sierra Vista Pharmacy, Inc.
• Sierra Vista Pharmacy, Inc.
• Sierra Vista Residential Care Home, Inc.
• Sierra Vista Residential Care Home,Inc

• Family Medicine Physician in Farmersville, CA
• Providers in Farmersville, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.