Individual provider Active NPI

Brad Sumrell, M.D.

  • Pediatrics Physician
  • Clovis, CA
National Provider Identifier
1952382749
Registry record updated Aug 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A40182 Issued in CA
Practice address
275 W Herndon Ave
Clovis, CA 93612-0204
Phone
(559) 324-6200
Fax
(559) 324-6280
NPI assigned
Nov 8, 2005
Last updated
Aug 22, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A40182 CA Primary

Addresses

Primary practice location

275 W Herndon Ave
Clovis, CA 93612-0204

Mailing address

275 W Herndon Ave
Clovis, CA 93612-0204
Phone (559) 324-6200

Other identifiers 3

IdentifierTypeStateIssuer
00A401820MedicaidCA
77040368493612B002OtherCACHAMPUS
00A401820OtherCABLUE CROSS/BLUE SHIELD

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050511000983 CA Practitioner - Pediatric Medicine 0042250771 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
40182CAMDGeneral Practice Dentistry
A40182CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Foundation Medical Group CurrentSince Apr 1, 2014 Accepting new patients
Community Foundation Medical Group CurrentSince Apr 1, 2014 Accepting new patients
Fresno Community Hospital and Medical Center Past Accepting new patients
Saint Agnes Medical Center Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Valley Children's Hospital Past Accepting new patients

Locations

275 W Herndon Ave
Clovis, CA 93612
Phone (559) 321-4255

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

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187740800000",
    "number": "1952382749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 W HERNDON AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936120204",
            "telephone_number": "559-324-6200",
            "fax_number": "559-324-6280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 W HERNDON AVE",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936120204",
            "telephone_number": "559-324-6200",
            "fax_number": "559-324-6280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMRELL",
        "first_name": "BRAD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2007-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A40182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A401820",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "77040368493612B002",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "00A401820",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, CA

Sources for this page

Verify at the official NPI Registry.