Central California Faculty Medical Group, Inc.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

CENTRAL CALIFORNIA FACULTY MEDICAL GROUP, INC.

Practice address

1247 E Alluvial Ave
Suite 101
Fresno, CA 93720-2686

Phone

(559) 431-6226

Fax

(559) 440-9005

NPI assigned

Feb 22, 2007

Last updated

Nov 20, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Karl P Van Gundy, MD

Title

President

Phone

(559) 453-5200

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

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

• Central California Faculty Medical Group, Inc.

  • Emergency Medicine Physician
  • Fresno, CA
  • NPI 1457603573

  O20031118001168

  Same enrollment
• Central California Faculty Medical Group, Inc.

  • Internal Medicine Physician
  • Clovis, CA
  • NPI 1992742852

  O20031118001168

  Same enrollment

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416441600000",
    "number": "1669507752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 E DIVISADERO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211431",
            "telephone_number": "559-443-2682",
            "fax_number": "559-443-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1247 E ALLUVIAL AVE",
            "address_2": "SUITE 101",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202686",
            "telephone_number": "559-431-6226",
            "fax_number": "559-440-9005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL CALIFORNIA FACULTY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2014-11-20",
        "status": "A",
        "authorized_official_last_name": "VAN GUNDY",
        "authorized_official_first_name": "KARL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "559-453-5200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC4679",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0014818",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Central Calif ENT Medical Group
• Central California Asthma Collaborative
• Central California Blood Center
• Central California Faculty Medical Group, Inc. (University Medical Supply)
• Central California Faculty Medical Group, Inc.
• Central California Family Medicine a Medical Corporation
• Central California Healthcare Incorporated (Therapeutic Home Healthcare)
• Central California Hip Institute
• Central California Hospital Medicine Group Inc
• Central California Medical Imaging

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.