Altamont Emergency Physicians Medical Group Inc
Organization Active NPI Emergency Medicine Physician · Tracy, CA
NPI 1952392375 · NPPES record last updated Apr 19, 2021
Key facts
- NPI
- 1952392375
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 34916 (CA)
- Legal business name
- ALTAMONT EMERGENCY PHYSICIANS MEDICAL GROUP INC
- Practice address
- 1420 N Tracy Blvd
Emergency Dept
Tracy, CA 95376-3451 - Phone
- (209) 342-2300
- Fax
- (209) 524-4240
- NPI assigned
- Nov 3, 2005
- Organization subpart
- No
Authorized official
- Name
- Janice Marie Crawford, MD
- Title
- President
- Phone
- (209) 342-2300
Practitioners 73
-
Yvonne Montero Cabero, FNP-C
-
Allen Chang, MD
-
Steven Deford, M.D.
-
Eider Garai Perez, FNP-BC
-
Phoebe Lee, M.D.
-
Alan Albert Ly, DO
-
Joseph Marc Mulevicz, N.P.
-
Thomas Peterson, DNP
-
Kimberly Pham, DO
-
Tamara L Reni, FNP-C
-
Katherine Shafer, M.D.
-
Livneet Kaur Takhar, FNP
-
Sean Wilkie, M.D.
-
Bradley Gao, MD
-
Easa Ghoreishi, MD
-
John Russell Gooch, M.D,
-
Aleq Jaffery, MD, MPH
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050318000840 | CA | Part B Supplier - Clinic/Group Practice | 5496700759 |
Receives reassigned benefits from 70 practitioners Practice locations: Tracy, CA |
National Provider Directory
Locations
1420 N Tracy Blvd
Tracy, CA 95376
Phone (209) 832-6018
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | 34916 | CA | Yes |
Addresses
Primary practice location
1420 N Tracy Blvd
Emergency Dept
Tracy, CA 95376-3451
Mailing address
450 Glass LN Ste C
Modesto, CA 95356-9287
Phone (209) 342-2300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ22800Z | Other | CA | BLUE SHIELD |
| GR0044000 | Medicaid | CA |
Other providers in Tracy, CA
- Rukea N Aljewad
- Michael K Allen
- Quenton Alley
- Howard H Allison
- Al Khan Cabanez Alsua
- Altamont Surgery Center
- Allan Jesus Alvarado
- Carlos Alvarado
- Jamie Leeann Alvarado
- Linnet Alvarado
All providers in Tracy, CA · Emergency Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.