Excell E.N.T. Medical Group, Inc.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

EXCELL E.N.T. MEDICAL GROUP, INC.

Practice address

645 W Harding Way
Suite 6
Stockton, CA 95204-5688

Phone

(209) 943-5185

Fax

(209) 943-5187

NPI assigned

Jun 5, 2006

Organization subpart

No

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

Authorized official

Name

Debra K Johnson

Title

Practice Administrator

Phone

(209) 943-5185

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 3

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

• Kristin Michelle Bennett, M.D.

  • Otolaryngology Physician
  • Stockton, CA
  • NPI 1922047299
  NPD (past)
• Ronald George Dong, M.D.

  • Otolaryngology Physician
  • Stockton, CA
  • NPI 1194764472
  NPD (past)
• Charles Sanford Johnson Jr., M.D.

  • Otolaryngology Physician
  • Stockton, CA
  • NPI 1831138106
  NPD (past)

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871532887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 W HARDING WAY",
            "address_2": "SUITE 6",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952045688",
            "telephone_number": "209-943-5185",
            "fax_number": "209-943-5187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 W HARDING WAY",
            "address_2": "SUITE 6",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952045688",
            "telephone_number": "209-943-5185",
            "fax_number": "209-943-5187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELL E.N.T. MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "209-943-5185"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ66439Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Otolaryngology Physician in Stockton, CA
• Providers in Stockton, CA by specialty
• Otolaryngology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.