Active 1 Prosthetics and Orthotics

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

ACTIVE 1 PROSTHETICS AND ORTHOTICS

Practice address

295 W Cromwell Ave
Suite 102
Fresno, CA 93711-6167

Phone

(559) 493-5020

Fax

(559) 492-3569

NPI assigned

Apr 17, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Stephan Mark Magill, C.P.O.NPI 1942497920

Title

President

Phone

(559) 493-5020

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

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

• Stephan M Magill, CPO

  • Prosthetist
  • Fresno, CA
  • NPI 1942497920
  NPD (past) Authorized official
• Bradley Lucich, C.P.

  • Prosthetist
  • Fresno, CA
  • NPI 1770770752
  NPD

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

{
    "created_epoch": "1429228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429228800000",
    "number": "1942697875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 W CROMWELL AVE",
            "address_2": "SUITE 102",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937116167",
            "telephone_number": "559-493-5020",
            "fax_number": "559-492-3569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 W CROMWELL AVE",
            "address_2": "SUITE 102",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937116167",
            "telephone_number": "559-493-5020",
            "fax_number": "559-492-3569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE 1 PROSTHETICS AND ORTHOTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-17",
        "last_updated": "2015-04-17",
        "status": "A",
        "authorized_official_last_name": "MAGILL",
        "authorized_official_first_name": "STEPHAN",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "559-493-5020",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C.P.O."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maribel Rodriguez Acosta
• Maximino Camacho Acosta
• Robert Acosta Jr.
• Sheridan Acosta, RN
• Yessica Acosta
• Acts Foundation
• Acts of Service
• Shawna M Acunia
• Acupuncture Clinic
• Thomas Glenn Adair, PA-C

• Prosthetic/Orthotic Supplier in Fresno, CA
• Providers in Fresno, CA by specialty
• Prosthetic/Orthotic Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.