Eag Professional Medical Corp.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A68296 Issued in CA

Legal business name

EAG PROFESSIONAL MEDICAL CORP.

Practice address

1809 Central Ave Ste C
Ceres, CA 95307-1806

Phone

(209) 537-4434

Fax

(209) 551-3255

NPI assigned

Aug 27, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Eleuterio Arcangel Go, M.D.NPI 1447219662

Title

President

Phone

(209) 537-4434

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 5

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

• Eleuterio Arcangel Go, M.D.

  • Specialist
  • Modesto, CA
  • NPI 1447219662

  Psychiatry

  Medicare reassignment NPD Authorized official
• Adriel Jonathan Go, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Modesto, CA
  • NPI 1669137402
  Medicare reassignment NPD
• Navneet Kaur

  • Psychiatric/Mental Health Nurse Practitioner
  • Merced, CA
  • NPI 1992287437
  Medicare reassignment NPD
• Medard Tolentino Sison, DNP, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Fresno, CA
  • NPI 1922507037
  Medicare reassignment NPD
• Sarah Fese Taylor, FNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Richmond, TX
  • NPI 1023413556

  CA

  Medicare reassignment NPD

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191369600000",
    "number": "1841483427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3512 HILLGLEN AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953557867",
            "telephone_number": "209-985-4813",
            "fax_number": "209-551-3255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 CENTRAL AVE STE C",
            "city": "CERES",
            "state": "CA",
            "postal_code": "953071806",
            "telephone_number": "209-537-4434",
            "fax_number": "209-551-3255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAG PROFESSIONAL MEDICAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-27",
        "last_updated": "2007-10-03",
        "status": "A",
        "authorized_official_last_name": "GO",
        "authorized_official_first_name": "ELEUTERIO",
        "authorized_official_middle_name": "ARCANGEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-537-4434",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A68296",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CA",
            "license": "A68296",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PPIN",
            "identifier": "00A682962",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6213236",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP ID",
            "identifier": "ZZZ01404Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Rose Duarte
• Shanika Duliepe, MSN, FNP-BC
• Alejandro Duran, PPS
• Griffin Allen Dye
• Felicia Dyer
• Thorn Eang, LVN
• Christine Marie Ehrler, RN
• Mary A Elese
• Elite Family Systems
• Elite Family Systems

• Psychiatry Physician in Ceres, CA
• Providers in Ceres, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2007; 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.