Central California Faculty Medical Group, Inc.
Organization Active NPI Internal Medicine Physician · Clovis, CA
NPI 1992742852 · NPPES record last updated Jun 13, 2025
Key facts
- NPI
- 1992742852
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- CENTRAL CALIFORNIA FACULTY MEDICAL GROUP, INC.
- Practice address
- 604 N Magnolia Ave Ste 100
Clovis, CA 93611-9205 - Phone
- (559) 320-0531
- Fax
- (559) 320-0539
- NPI assigned
- Jun 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Randall Stern, MD
- Title
- President
- Phone
- (559) 443-2682
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 1
Practitioners 518
-
Lauren Aguilar, PA
-
Naeem M. Akhtar, MD
-
Keiko Amano, MD
-
Nahia J Amoura, MD
-
Gerson P Araujo, M.D.
-
Kam Lun Robert Au Yeung, M.D.
-
Thomas Benjamin Auerbach, PA-C
-
Mark Ayoub, MD
-
Hila Azulay, M.D.
-
Robert R Baber, PA-C
-
Varsha Babu, MD
-
Manpreet Bassi, MD
-
Leah Bauer, MD, MPH
-
Jordan L Beshore, D.O.
-
Aleyna Besmer, MS, RD
-
Matthew Ryan Beutner, M.D.
-
Brian William Blake, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031118001168 | CA | Part B Supplier - Clinic/Group Practice | 8325952773 |
Receives reassigned benefits from 333 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fresno, CA; Madera, CA; Clovis, CA |
| O20250613002516 | CA | DME Supplier - Physician - Internal Medicine | 8325952773 | Practice locations: Clovis, CA |
National Provider Directory
Locations
729 N Medical Center Dr W
Ste 11
Clovis, CA 93611
2335 E Kashian Ln
Ste 1301
Fresno, CA 93701
2210 E Illinois Ave
Ste 302
Fresno, CA 93701
351 E Barstow Ave
Ste 106
Fresno, CA 93710
Phone (559) 227-4472
2823 Fresno St
Fl 5
Fresno, CA 93721
7015 N Chestnut Ave
Ste 101
Fresno, CA 93720
Phone (559) 326-1010
2210 E Illinois Ave
Ste 204
Fresno, CA 93701
7025 N Chestnut Ave
Ste 105
Fresno, CA 93720
Phone (559) 233-3376
2335 E Kashian Ln
Ste 310
Fresno, CA 93701
6311 N Fresno St
Ste 106
Fresno, CA 93710
Phone (559) 435-4700
15 E Audubon Dr
Fresno, CA 93720
Phone (559) 433-8000
2027 E Divisadero St
Fresno, CA 93701
Phone (559) 320-0580
2210 E Illinois Ave
Ste 401
Fresno, CA 93701
Phone (559) 320-0531
2210 E Illinois Ave
Ste 408
Fresno, CA 93701
Phone (559) 443-2694
2027 E Divisadero St
Ste 227
Fresno, CA 93701
2335 E Kashian Ln
Ste 301
Fresno, CA 93701
Phone (559) 224-5864
4910 E Clinton Way
Ste 101
Fresno, CA 93727
Phone (559) 453-5200
2900 Fresno St
Ste 101
Fresno, CA 93721
Phone (559) 227-4472
2823 Fresno St
Los Angeles, CA 90088
2511 Logan St
Selma, CA 93662
Phone (209) 896-2624
2101 Stone Blvd
Ste 240
West Sacramento, CA 95691
Phone (916) 376-8416
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Adolescent Medicine (Family Medicine) Physician |
207QA0000X | |||
| Adult Medicine Physician |
207QA0505X | |||
| Internal Medicine Physician |
207R00000X | Yes | ||
| Cardiovascular Disease Physician |
207RC0000X | |||
| Critical Care Medicine (Internal Medicine) Physician |
207RC0200X | |||
| Endocrinology, Diabetes & Metabolism Physician |
207RE0101X | |||
| Gastroenterology Physician |
207RG0100X | |||
| Hematology & Oncology Physician |
207RH0003X | |||
| Interventional Cardiology Physician |
207RI0011X | |||
| Infectious Disease Physician |
207RI0200X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Pediatrics Physician |
208000000X | |||
| Neurology Physician |
2084N0400X |
Addresses
Primary practice location
604 N Magnolia Ave Ste 100
Clovis, CA 93611-9205
Mailing address
2625 E Divisadero St
Fresno, CA 93721-1431
Phone (559) 453-5200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0077241 | Medicaid | CA | |
| GPS000540 | Medicaid | CA | |
| ZZZ83317Z | Medicaid | CA | |
| GRE001360 | Medicaid | CA | |
| GR0077244 | Medicaid | CA |
Other providers in Clovis, CA
- Ronald Dan Caton
- Lesley Yvonne Celio-Ramirez
- Cencal Medical Transport LLC
- Central Cal Speech Inc
- Central California Chest Surgery
- Central Valley Behavioral Health Psychology Corporation
- Central Valley Behavioral Health Psychology Corporation
- Central Valley Indian Health
- Central Valley Indian Health, Inc
- Central Valley Indian Health, Inc
All providers in Clovis, CA · Internal 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 Jun 13, 2025. 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.