NPIMap

Organization Active NPI

Los Banos Medical Group a Medical Corporation

  • Internal Medicine Physician
  • Los Banos, CA
National Provider Identifier
1801961925
Registry record updated Jan 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LOS BANOS MEDICAL GROUP A MEDICAL CORPORATION
Practice address
400 West I Street
Suite a
Los Banos, CA 93635
Phone
(209) 826-3200
Fax
(209) 827-9184
NPI assigned
Nov 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2010

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

Authorized official

Name
Dr. Jason R Mevi, MD
Title
President
Phone
(209) 826-3200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

400 West I Street
Suite a
Los Banos, CA 93635

Mailing address

400 West I Street
Suite a
Los Banos, CA 93635
Phone (209) 826-3200

Other identifiers 1

IdentifierTypeStateIssuer
GR0101020MedicaidCA

National Provider Directory

National Provider Directory

Locations

245 H St
Ste 2
Los Banos, CA 93635
Phone (209) 826-3200

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263427200000",
    "number": "1801961925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 WEST I STREET",
            "address_2": "SUITE A",
            "city": "LOS BANOS",
            "state": "CA",
            "postal_code": "93635",
            "telephone_number": "209-826-3200",
            "fax_number": "209-827-9184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 WEST I STREET",
            "address_2": "SUITE A",
            "city": "LOS BANOS",
            "state": "CA",
            "postal_code": "93635",
            "telephone_number": "209-826-3200",
            "fax_number": "209-827-9184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOS BANOS MEDICAL GROUP A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2010-01-14",
        "status": "A",
        "authorized_official_last_name": "MEVI",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-826-3200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0101020",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Banos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2010; 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.