San Joaquin Prime Care Medical Group Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A43893 Issued in CA

Legal business name

SAN JOAQUIN PRIME CARE MEDICAL GROUP INC

Practice address

30924 E Kings Canyon Rd
Squaw Valley, CA 93675-9601

Phone

(559) 332-9399

Fax

(559) 332-9499

NPI assigned

Sep 26, 2007

Last updated

Apr 27, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly Burgins

Title

Billing Supervisor

Phone

(559) 783-1181

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430092800000",
    "number": "1982891735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 E PINE ST",
            "city": "EXETER",
            "state": "CA",
            "postal_code": "932211838",
            "telephone_number": "559-592-2134",
            "fax_number": "559-592-2017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30924 E KINGS CANYON RD",
            "city": "SQUAW VALLEY",
            "state": "CA",
            "postal_code": "936759601",
            "telephone_number": "559-332-9399",
            "fax_number": "559-332-9499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOAQUIN PRIME CARE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-26",
        "last_updated": "2015-04-27",
        "status": "A",
        "authorized_official_last_name": "BURGINS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "559-783-1181"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A43893",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "058928",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0084782",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Squaw Valley, CA
• Providers in Squaw Valley, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.