NPIMap

Organization Active NPI

Specialty Medical Group Central California - Dept of Otolaryngology

  • Pediatric Otolaryngology Physician
  • Madera, CA
National Provider Identifier
1861673246
Registry record updated Jun 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Otolaryngology PhysicianTaxonomy code 207YP0228X
Legal business name
SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT OF OTOLARYNGOLOGY
Practice address
9300 Valley Childrens PL
Se18
Madera, CA 93636-8761
Phone
(559) 353-6453
Fax
(559) 353-6457
NPI assigned
Nov 14, 2007
Organization subpart
Yes
Parent organization
SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2013

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

Authorized official

Name
Devonna M. Kaji, M.D.
Title
President and Medical Director
Phone
(559) 353-5016

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X CA
Pediatric Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YP0228X CA Primary

Addresses

Primary practice location

9300 Valley Childrens PL
Se18
Madera, CA 93636-8761

Mailing address

9300 Valley Childrens PL
Madera, CA 93636-8761
Phone (559) 353-6453

Other identifiers 2

IdentifierTypeStateIssuer
GR007868JMedicaidCA
1013968296OtherCASMG GENERAL GROUP NPI NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Vly Child Spec Med GRP Inc29 organizations share this tax ID, including this one
Part of
Vly Child Spec Med GRP Inc

Other organizations with this tax ID 28

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

View all 28

Locations

9300 Valley Childrens Pl
#18
Madera, CA 93636
Phone (559) 353-6022

Practitioners & affiliated clinicians

Practitioners 8

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": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372377600000",
    "number": "1861673246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9300 VALLEY CHILDRENS PL",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "936368761",
            "telephone_number": "559-353-6453",
            "fax_number": "559-353-6457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 VALLEY CHILDRENS PL",
            "address_2": "SE18",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "936368761",
            "telephone_number": "559-353-6453",
            "fax_number": "559-353-6457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT OF OTOLARYNGOLOGY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA, INC.",
        "enumeration_date": "2007-11-14",
        "last_updated": "2013-06-28",
        "status": "A",
        "authorized_official_last_name": "KAJI",
        "authorized_official_first_name": "DEVONNA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT AND MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "559-353-5016",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "207YP0228X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR007868J",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SMG GENERAL GROUP NPI NUMBER",
            "identifier": "1013968296",
            "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 Jun 28, 2013; 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.