Active NPI
Michael J Ebaugh, MD
- Specialist
- Porterville, CA
National Provider Identifier
1609965797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- A65845
- Practice address
- 254 N Kessing St
Porterville, CA 93257-3424 - Phone
- (559) 781-8500
- Fax
- (559) 781-8300
- NPI assigned
- Oct 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | A65845 | CA | Primary |
Addresses
Primary practice location
254 N Kessing St
Porterville, CA 93257-3424
Mailing address
254 N Kessing St
Porterville, CA 93257-3424
Phone (559) 781-8500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ06893Z | Other | CA | BLUE SHIELD |
| GR0099940 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A65845 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609965797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "254 N KESSING ST",
"city": "PORTERVILLE",
"state": "CA",
"postal_code": "932573424",
"telephone_number": "559-781-8500",
"fax_number": "559-781-8300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "254 N KESSING ST",
"city": "PORTERVILLE",
"state": "CA",
"postal_code": "932573424",
"telephone_number": "559-781-8500",
"fax_number": "559-781-8300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBAUGH",
"first_name": "MICHAEL",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "A65845",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "ZZZ06893Z",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0099940",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Porterville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.