Organization Active NPI

Pribyl Montague Medical Corporation

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Napa, CA
National Provider Identifier
1952169682
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
PRIBYL MONTAGUE MEDICAL CORPORATION
Practice address
3434 Villa LN Ste 380
Napa, CA 94558-6416
Phone
(707) 646-4414
NPI assigned
Mar 7, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Authorized official

Name
Shea Pribyl, DONPI 1639336050
Title
President
Phone
(707) 646-4414

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
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208G00000X Primary

Addresses

Primary practice location

3434 Villa LN Ste 380
Napa, CA 94558-6416

Mailing address

1860 Pennsylvania Ave
Fairfield, CA 94533-3590
Phone (707) 646-4414

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240604001265 CA Part B Supplier - Clinic/Group Practice 9032651286 Receives reassigned benefits from 1 practitioner
Practice locations: Napa, CA; Saint Helena, CA

National Provider Directory

National Provider Directory

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": "1709769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1952169682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 PENNSYLVANIA AVE",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945333590",
            "telephone_number": "707-646-4414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 VILLA LN STE 380",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945586416",
            "telephone_number": "707-646-4414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIBYL MONTAGUE MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-07",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "PRIBYL",
        "authorized_official_first_name": "SHEA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-646-4414",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Napa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; 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.