Gastroenterology and Liver Disease Medical Center Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

AS1593001 Issued in CA

Legal business name

GASTROENTEROLOGY AND LIVER DISEASE MEDICAL CENTER INC

Practice address

7215 N Fresno St
#101
Fresno, CA 93720-2969

Phone

(559) 449-0309

Fax

(559) 449-0609

NPI assigned

May 30, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Audra E Orbaker

Title

Administrator

Phone

(559) 760-9981

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Gastroenterology and Liver Disease Medical Center IncCCN 05C0001593

Medicare certification status

ActiveFrom the Provider of Services file

Locations

Practitioners 1

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

• Ram Lal Mittal, MD

  • Gastroenterology Physician
  • Fresno, CA
  • NPI 1306893516
  Medicare reassignment

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710979200000",
    "number": "1780631127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7215 N FRESNO ST",
            "address_2": "#101",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202969",
            "telephone_number": "559-449-0309",
            "fax_number": "559-449-0609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7215 N FRESNO ST",
            "address_2": "#101",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202969",
            "telephone_number": "559-449-0309",
            "fax_number": "559-449-0609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROENTEROLOGY AND LIVER DISEASE MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-30",
        "last_updated": "2024-03-21",
        "certification_date": "2022-01-27",
        "status": "A",
        "authorized_official_last_name": "ORBAKER",
        "authorized_official_first_name": "AUDRA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "559-760-9981",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "AS1593001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZH1024Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SUR01593F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paulina M Gastelum Figueroa, BCBA
• Chantal Gastelum
• Erica Mariel Tolentino Gastelum, M.D.
• Nicholas Steven Gastelum, M.D.
• Gaston Middle School
• Jennifer Gatchalian
• Christopher Russell Gates, DMD
• Lamain Gates
• Gateway 2 Hearing
• Gateway Counseling Group Licensed Clinical Social Workers Inc

• Clinic/Center in Fresno, CA
• Providers in Fresno, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 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.