NPIMap

Organization Active NPI

Specialty Medical Group Central California - Dept. of Nephrology

  • Pediatric Nephrology Physician
  • Madera, CA
National Provider Identifier
1710168919
Registry record updated Nov 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nephrology PhysicianTaxonomy code 2080P0210X
Legal business name
SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT. OF NEPHROLOGY
Practice address
9300 Valley Childrens PL
Se13
Madera, CA 93636-8761
Phone
(559) 353-5770
Fax
(559) 353-5822
NPI assigned
Nov 16, 2007
Last updated
Nov 16, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 16, 2007

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

Authorized official

Name
Ralph P. Diaz, M.D.
Title
President / Medical Director
Phone
(559) 353-5700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X CA
Pediatric Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0210X CA Primary

Addresses

Primary practice location

9300 Valley Childrens PL
Se13
Madera, CA 93636-8761

Mailing address

9300 Valley Childrens PL
Se13
Madera, CA 93636-8761
Phone (559) 353-5770

Other identifiers 1

IdentifierTypeStateIssuer
GR007868AMedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Specialty Medical Group Central California Inc - Dept of Oncology29 organizations share this tax ID, including this one
Part of
Specialty Medical Group Central California Inc - Dept of Oncology

Other organizations with this tax ID 28

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

View all 28

Practitioners & affiliated clinicians

Practitioners 2

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": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195171200000",
    "number": "1710168919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9300 VALLEY CHILDRENS PL",
            "address_2": "SE13",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "936368761",
            "telephone_number": "559-353-5770",
            "fax_number": "559-353-5822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 VALLEY CHILDRENS PL",
            "address_2": "SE13",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "936368761",
            "telephone_number": "559-353-5770",
            "fax_number": "559-353-5822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT. OF NEPHROLOGY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA INC.",
        "enumeration_date": "2007-11-16",
        "last_updated": "2007-11-16",
        "status": "A",
        "authorized_official_last_name": "DIAZ",
        "authorized_official_first_name": "RALPH",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT / MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "559-353-5700",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0210X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR007868A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madera, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 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.