Active NPI
Stephen Demosthenes Fonsworth
- Community Health Worker
- Ceres, CA
National Provider Identifier
1851152052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 1708 Banyan CT
Ceres, CA 95307-1907 - Phone
- (209) 538-1888
- NPI assigned
- Jan 16, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
1708 Banyan CT
Ceres, CA 95307-1907
Mailing address
2935 4TH St
Ceres, CA 95307-3222
Phone (209) 538-9009
Other practice location 1
3607 Blaker Rd
Ceres, CA 95307-9503
Phone (209) 531-1783
Other practice location 2
3212 Uranus Dr
Ceres, CA 95307-3010
Phone (209) 538-4038
Other practice location 3
2528 Leslie Ln
Ceres, CA 95307-2326
Phone (209) 538-7331
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714608000000",
"number": "1851152052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2935 4TH ST",
"city": "CERES",
"state": "CA",
"postal_code": "953073222",
"telephone_number": "209-538-9009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1708 BANYAN CT",
"city": "CERES",
"state": "CA",
"postal_code": "953071907",
"telephone_number": "209-538-1888"
}
],
"practiceLocations": [
{
"address_1": "3607 Blaker Rd",
"address_purpose": "LOCATION",
"city": "Ceres",
"state": "CA",
"postal_code": "953079503",
"country_code": "US",
"telephone_number": "209-531-1783",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3212 Uranus Dr",
"address_purpose": "LOCATION",
"city": "Ceres",
"state": "CA",
"postal_code": "953073010",
"country_code": "US",
"telephone_number": "209-538-4038",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2528 Leslie Ln",
"address_purpose": "LOCATION",
"city": "Ceres",
"state": "CA",
"postal_code": "953072326",
"country_code": "US",
"telephone_number": "209-538-7331",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FONSWORTH",
"first_name": "STEPHEN",
"middle_name": "DEMOSTHENES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-16",
"last_updated": "2024-05-02",
"certification_date": "2024-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ceres, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.