NPIMap

Organization Active NPI

CMG Medical Group, Inc.

  • Family Medicine Physician
  • Morro Bay, CA
National Provider Identifier
1649356908
Registry record updated Oct 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C1935201 Issued in CA
Legal business name
CMG MEDICAL GROUP, INC.
Practice address
665 Main St
Suite B
Morro Bay, CA 93442-2269
Phone
(805) 771-8365
Fax
(805) 771-9242
NPI assigned
Oct 30, 2006
Last updated
Oct 18, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2007

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

Authorized official

Name
Dr. Steven B. Goodman, M.D.NPI 1295775328
Title
President
Phone
(805) 771-8365

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X C1935201 CA Primary

Addresses

Primary practice location

665 Main St
Suite B
Morro Bay, CA 93442-2269

Mailing address

1555 Higuera St
San Luis Obispo, CA 93401-2917
Phone (805) 543-4043

Other identifiers 2

IdentifierTypeStateIssuer
GR0069892MedicaidCA
ZZZ55765ZOtherCABLUE SHIELD OF CA

National Provider Directory

National Provider Directory

Locations

665 Main St
Ste B
Morro Bay, CA 93442
Phone (805) 771-8324

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192665600000",
    "number": "1649356908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 HIGUERA ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012917",
            "telephone_number": "805-543-4043",
            "fax_number": "805-543-4427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 MAIN ST",
            "address_2": "SUITE B",
            "city": "MORRO BAY",
            "state": "CA",
            "postal_code": "934422269",
            "telephone_number": "805-771-8365",
            "fax_number": "805-771-9242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CMG MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-30",
        "last_updated": "2007-10-18",
        "status": "A",
        "authorized_official_last_name": "GOODMAN",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-771-8365",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C1935201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0069892",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA",
            "identifier": "ZZZ55765Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morro Bay, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.

Verify at the official NPI Registry.