Organization Active NPI

Muscular Skeletal Medical Associates, Inc

  • Immunopathology Physician
  • Fresno, CA
National Provider Identifier
1902905755
Registry record updated May 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Immunopathology PhysicianTaxonomy code 207ZI0100X
License
020A53070 Issued in CA
Legal business name
MUSCULAR SKELETAL MEDICAL ASSOCIATES, INC
Practice address
3726 N 1St St
Fresno, CA 93726-5601
Phone
(559) 248-0116
Fax
(559) 248-0119
NPI assigned
Sep 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2020

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

Authorized official

Name
Daniel B. Brubaker, D.O.NPI 1467559526
Title
Owner
Phone
(559) 248-0116

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Immunopathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZI0100X 020A53070 CA Primary

Addresses

Primary practice location

3726 N 1St St
Fresno, CA 93726-5601

Mailing address

3726 N 1St St
Fresno, CA 93726-5601
Phone (559) 248-0116

Other identifiers 1

IdentifierTypeStateIssuer
B58262MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041123000739 CA Part B Supplier - Clinic/Group Practice 2769447309 Receives reassigned benefits from 1 practitioner
Practice locations: Fresno, CA

National Provider Directory

National Provider Directory

Locations

1642 E Herndon Ave
Fresno, CA 93720
Phone (323) 359-4898

1642 E Herndon Ave
Ste 104
Fresno, CA 93720
Phone (559) 248-0116

2501 W Shaw Ave
Ste 113
Fresno, CA 93711
Phone (559) 507-3760

3726 N 1st St
Fresno, CA 93726
Phone (559) 248-0116

1910 W Whitendale Ave
Visalia, CA 93277
Phone (559) 930-9051

Practitioners & affiliated clinicians

Practitioners 1

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": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588291200000",
    "number": "1902905755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3726 N 1ST ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937265601",
            "telephone_number": "559-248-0116",
            "fax_number": "559-248-0119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3726 N 1ST ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937265601",
            "telephone_number": "559-248-0116",
            "fax_number": "559-248-0119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUSCULAR SKELETAL MEDICAL ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2020-05-01",
        "certification_date": "2020-05-01",
        "status": "A",
        "authorized_official_last_name": "BRUBAKER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "559-248-0116",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207ZI0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Immunopathology",
            "state": "CA",
            "license": "020A53070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B58262",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2020; 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.