NPIMap

Organization Active NPI

Premium Urgent Care, Inc.

  • Urgent Care Clinic/Center
  • Fresno, CA
National Provider Identifier
1619747623
Registry record updated Jan 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
PREMIUM URGENT CARE, INC.
Practice address
1069 E Champlain Dr
Fresno, CA 93720-4223
Phone
(559) 797-4315
Fax
(559) 321-8730
NPI assigned
Jan 2, 2024
Organization subpart
Yes
Parent organization
PREMIUM URGENT CARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 2, 2024

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

Authorized official

Name
Erick Joseph Green, MDNPI 1821371022
Title
Owner
Phone
(504) 236-1486

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

1069 E Champlain Dr
Fresno, CA 93720-4223

Mailing address

2021 Herndon Ave Ste 101
Clovis, CA 93611-6316
Phone (559) 797-4315

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131223000834 CA Part B Supplier - Clinic/Group Practice 9638306533 Receives reassigned benefits from 11 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clovis, CA; Fresno, CA; Los Banos, CA; Selma, CA

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2305092Premium Urgent Care Inc1069 E Champlain Dr, Fresno, CA 93720Certificate of waiverMay 22, 2028

National Provider Directory

National Provider Directory
Tax ID family
Premium Urgent Care Inc7 organizations share this tax ID, including this one
Part of
Premium Urgent Care Inc

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6643 N Milburn Ave
Fresno, CA 93722
Phone (559) 275-1400

1069 E Champlain Dr
Fresno, CA 93720
Phone (559) 494-4446

505 N Clovis Ave
Ste B
Fresno, CA 93727
Phone (559) 387-5230

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1704153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704153600000",
    "number": "1619747623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 HERNDON AVE STE 101",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936116316",
            "telephone_number": "559-797-4315",
            "fax_number": "559-321-8730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1069 E CHAMPLAIN DR",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937204223",
            "telephone_number": "559-797-4315",
            "fax_number": "559-321-8730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM URGENT CARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIUM URGENT CARE, INC.",
        "enumeration_date": "2024-01-02",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "ERICK",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-236-1486",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.