CENTRAL CALIFORNIA FACULTY MEDICAL GROUP, INC. (NPI# 1669507752) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669507752 |
| Entity Type | Organization |
| Organization Name | CENTRAL CALIFORNIA FACULTY MEDICAL GROUP, INC. |
| Practice Address |
1247 E Alluvial Ave Suite 101 Fresno CA 93720-2686 |
| Mailing Address |
2625 E Divisadero St Fresno CA 93721-1431 |
| Practice Telephone | 5594316226 |
| Practice Fax Number | 5594409005 |
| Mailing Telephone | 5594432682 |
| Mailing Fax Number | 5594432681 |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2014-11-20 |
| Authorized Official Name | DR. KARL P VAN GUNDY (PRESIDENT) |
| Authorized Official Telephone | 5594535200 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213E00000X | Podiatrist | Podiatric Medicine & Surgery Service Providers | ||
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR0014818 | 05 | |
| CA | RAILROAD MEDICARE | DC4679 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124426705 | Central California Faculty Medical Group, Inc. | Durable Medical Equipment & Medical Supplies | 2554 Merced Street, Fresno, CA 93721 | 2014-12-12 |
| 1205971595 | Central California Faculty Medical Group, Inc. | Neurological Surgery | 7415 N Cedar Ave, Suite 102, Fresno, CA 93720-3834 | 2007-02-21 |
| 1992742852 | Central California Faculty Medical Group, Inc. | Family Medicine | 2625 E Divisadero St, Fresno, CA 93721-1431 | 2006-06-01 |
| 1457603573 | Central California Faculty Medical Group, Inc. | Emergency Medicine | 2823 Fresno St, Fresno, CA 93721-1324 | 2012-10-12 |
| Street Address |
1247 E ALLUVIAL AVE SUITE 101 |
| City | FRESNO |
| State | CA |
| Zip Code | 93720-2686 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548242662 | Kenneth Bangs | Nurse Practitioner | 1247 E Alluvial Ave, Suite 101, Fresno, CA 93720-2686 | 2005-11-15 |
| 1053707901 | Joseph Calcagno | Orthotist | 1247 E Alluvial Ave, Suite 103, Fresno, CA 93720-2686 | 2015-04-07 |
| 1881092963 | University Faculty Associates, Inc. | Podiatrist | 1247 E Alluvial Ave, Suite 101, Fresno, CA 93720-2686 | 2014-12-05 |
| 1114281557 | Emmy Agwu Oji | Podiatrist | 1247 E Alluvial Ave, Suite 101, Fresno, CA 93720-2686 | 2012-06-29 |
| 1629392568 | Shawn Michael Cazzell | Podiatrist | 1247 E Alluvial Ave, Suite 101, Fresno, CA 93720-2686 | 2010-03-22 |
| 1164695359 | Valley Orthopedic Inc | Durable Medical Equipment & Medical Supplies | 1247 E Alluvial Ave, Suite 103, Fresno, CA 93720-2686 | 2008-04-08 |
| 1881799161 | William E Hadcock, Jr, Md, Inc. | Surgery | 1247 E Alluvial Ave, Ste. 101, Fresno, CA 93720-2686 | 2006-09-13 |
| 1154353795 | William E Hadcock | Surgery | 1247 E Alluvial Ave, Ste. 101, Fresno, CA 93720-2686 | 2006-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366061129 | Ariel Lok Yen Leung | Student in an Organized Health Care Education/Training Program | 1313 East Herndon Ave, St 105, Fresno, CA 93720 | 2020-04-13 |
| 1457992513 | Brittany Nichole Willis | Audiologist | 1351 E Spruce Ave Ste 130, Fresno, CA 93720 | 2019-09-30 |
| 1013567668 | Taylor Courteney Cox | Physical Therapist | 7080 N. Maple Ave #101, Fresno, CA 93720 | 2019-09-16 |
| 1457909152 | Lillian M Augilera | Technician | 8419 N Dearing Ave, Fresno, CA 93720 | 2019-08-27 |
| 1215581764 | Sterling Hospitalist Medical Group, Inc. | Clinic/Center | 1191 E. Herndon Avenue Suite 103, Fresno, CA 93720 | 2019-08-01 |
| 1376006429 | Nancy Minh Thao Dang | Student in an Organized Health Care Education/Training Program | 1313 E. Herndon Ave, St 105, Fresno, CA 93720 | 2019-04-06 |
| 1366904716 | Shankar Nair | Student in an Organized Health Care Education/Training Program | 1313 E. Herndon Ave, St 105., Fresno, CA 93720 | 2019-04-04 |
| 1861979544 | Powell Pediatric Dentistry Chestnut Partnership | Dentist | 7005 N. Chestnut Ave Ste 101, Fresno, CA 93720 | 2018-07-25 |
| 1669967311 | Sierra Pacific Orthopaedic Center Medical Group Inc | Specialist | 1270 E. Spruce, Fresno, CA 93720 | 2018-06-26 |
| 1689168700 | Vinita Vishnoi | Student in an Organized Health Care Education/Training Program | 1313 E. Herndon Ave, St 105, Fresno, CA 93720 | 2018-06-21 |
| Find all providers in zip 93720 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265714620 | Vascular and Cardiothoracic Surgical Group, Inc | Surgery | 4650 N Palm Ave, Fresno, CA 93704-3035 | 2011-09-12 |
| 1073775748 | Soohyun Kim | Surgery | 1191 E Herndon Ave Ste 102, Fresno, CA 93720-3164 | 2008-06-25 |
| 1912033853 | Fitzalbert Michael Marius Sr. | Surgery | 3222 W Kearney Blvd, Fresno, CA 93706-2215 | 2007-02-26 |
| 1467454686 | Eric Ladenheim | Surgery | 6145 N Thesta St, Fresno, CA 93710-5266 | 2005-06-01 |
| 1114005246 | John Geren Nichols | Surgery | 7300 N Fresno St, Fresno, CA 93720-2941 | 2006-11-02 |
| 1881772614 | Abed Y. Joseph | Surgery | 7300 N Fresno St, Fresno, CA 93720-2941 | 2006-11-01 |
| 1073619870 | Andras Bikk | Surgery | 2615 E Clinton Ave, Va-central California Dept of Surgery -112, Fresno, CA 93703-2223 | 2006-09-16 |
| 1881799161 | William E Hadcock, Jr, Md, Inc. | Surgery | 1247 E Alluvial Ave, Ste. 101, Fresno, CA 93720-2686 | 2006-09-13 |
| 1154353795 | William E Hadcock | Surgery | 1247 E Alluvial Ave, Ste. 101, Fresno, CA 93720-2686 | 2006-07-06 |
| 1083655534 | James Ho Lee | Surgery | 1191 E Herndon Ave, #102, Fresno, CA 93720-3164 | 2006-06-08 |
| Find all providers in FRESNO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.