NPIMap

Organization Active NPI

Merced Faculty Associates Medical Group Incorporated

Doing business as MFA Medical Group Gateway Clinic

  • Obstetrics & Gynecology Physician
  • Merced, CA
National Provider Identifier
1548469174
Registry record updated Jul 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED
Doing business as
MFA Medical Group Gateway Clinic
Practice address
378 W Olive Ave
Suite D
Merced, CA 95348-3182
Phone
(209) 725-7560
Fax
(209) 725-7561
NPI assigned
Jul 13, 2007
Last updated
Jul 15, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2014

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
Obstetrics & Gynecology Physician 207V00000X NU Primary

Addresses

Primary practice location

378 W Olive Ave
Suite D
Merced, CA 95348-3182

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
CS1342OtherGARAILROAD MEDICARE
ZZZ09267ZOtherCABLUE SHIELD GROUP NUMBER
GR0041481MedicaidCAMEDI-CAL GROUP NUMBER

Other names 1

  • MFA Medical Group Gateway Clinic 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": "1405382400000",
    "number": "1548469174",
    "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": "378 W OLIVE AVE",
            "address_2": "SUITE D",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953483182",
            "telephone_number": "209-725-7560",
            "fax_number": "209-725-7561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-13",
        "last_updated": "2014-07-15",
        "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": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "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 NUMBER",
            "identifier": "ZZZ09267Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": "MEDI-CAL GROUP NUMBER",
            "identifier": "GR0041481",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MFA Medical Group Gateway Clinic",
            "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 Jul 15, 2014; 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.