Individual provider Active NPI

Denise Amezcua, PA-C

  • Physician Assistant
  • Fresno, CA
National Provider Identifier
1861887853
Registry record updated Jul 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
52254 Issued in CA
Practice address
2740 S Elm Ave
Fresno, CA 93706-5435
Phone
(559) 457-5200
NPI assigned
Apr 6, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 52254 CA Primary

Addresses

Primary practice location

2740 S Elm Ave
Fresno, CA 93706-5435

Mailing address

2740 S Elm Ave
Fresno, CA 93706-5435
Phone (559) 457-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150820009612 CA Practitioner - Physician Assistant 3779898754 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Foundation Medical GroupGroup PAC ID 0345406294, 282 clinicians

Practice addresses (Care Compare)

1429 N Acacia Ave
Reedley, CA 93654-2102
Phone (559) 638-2522

2335 E Kashian LN
Fresno, CA 93701-2234

7355 N Palm Ave
Fresno, CA 93711-5770

Hospital & facility affiliations

  • Clovis Community Medical Center Hospital, Clovis, CA, CCN 050492
  • Community Regional Medical Center Hospital, Fresno, CA, CCN 050060
  • Adventist Health Reedley Hospital, Reedley, CA, CCN 050192

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Community Foundation Medical Group CurrentSince Jun 1, 2021 Accepting new patients
Community Foundation Medical Group CurrentSince Jun 1, 2021 Accepting new patients

Locations

2335 E Kashian Ln
Ste 270
Fresno, CA 93701
Phone (559) 445-1251

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1428278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437350400000",
    "number": "1861887853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 S ELM AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937065435",
            "telephone_number": "559-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 S ELM AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937065435",
            "telephone_number": "559-457-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMEZCUA",
        "first_name": "DENISE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-06",
        "last_updated": "2015-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "52254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.