Sergio Ilic

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

A31668 Issued in CA

Practice address

7033 N Fresno St
201
Fresno, CA 93720-2976

Phone

(559) 435-5581

Fax

(559) 435-5583

NPI assigned

Aug 30, 2006

Last updated

Jul 20, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Central California Faculty Medical Group, Inc.

  • Internal Medicine Physician
  • Clovis, CA
  • NPI 1992742852

  Orthopaedic Surgery

  NPD (past)
• Charles J. Heller, MD. Inc.

  • Occupational Medicine Clinic/Center
  • Fresno, CA
  • NPI 1902946544
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279584000000",
    "number": "1538279013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7033 N FRESNO ST STE 201",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202976",
            "telephone_number": "559-435-5581",
            "fax_number": "559-435-5583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7033 N FRESNO ST",
            "address_2": "201",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202976",
            "telephone_number": "559-435-5581",
            "fax_number": "559-435-5583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILIC",
        "first_name": "SERGIO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2010-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A31668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A316680",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Audra Lynn Iknoian, PHARMD
• Ikon Equity Solutions Cor
• Ildefonso Cruz M D a Professional Corp
• Ildefonso Cruz MD Medical Corporation
• Daniel Edward Ildefonso, CADTP 22439
• Michael Illingworth, M.D.
• Imaba Inc.
• Imagine You, Inc
• April Amber Imboden
• Imc Care Home, Inc

• Orthopaedic Surgery Physician in Fresno, CA
• Providers in Fresno, CA by specialty
• Orthopaedic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.