SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT OF NEUROSURGERY (NPI# 1508047986) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508047986 |
| Entity Type | Organization |
| Organization Name | SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT OF NEUROSURGERY |
| Practice Address |
9300 Valley Childrens Pl Ge07 Madera CA 93636-8761 |
| Practice Telephone | 5593536277 |
| Practice Fax Number | 5593535424 |
| Mailing Telephone | 5593536277 |
| Mailing Fax Number | 5593535424 |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2013-06-28 |
| Authorized Official Name | DEVONNA M. KAJI (PRESIDENT / MEDICAL DIRECTOR) |
| Authorized Official Telephone | 5593535700 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | CA | Allopathic & Osteopathic Physicians | |
| Y | 207T00000X | Neurological Surgery | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | SMG GENERAL GRP NPI NUMBER | 1013968296 | 01 |
| CA | GR007868F | 05 |
| Street Address |
9300 VALLEY CHILDRENS PL GE07 |
| City | MADERA |
| State | CA |
| Zip Code | 93636-8761 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962405753 | Fred H Laningham | Radiology | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2005-05-24 |
| 1043811953 | Ashley Nicole Peton | Pharmacist | 9300 Valley Childrens Pl, Madera, CA 93636-8762 | 2020-11-06 |
| 1063013308 | Samantha Carballo Austin | Social Worker | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2020-11-03 |
| 1982205217 | Stefanie Marie Gibbons | Social Worker | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2020-11-03 |
| 1114525128 | Kristin Leann Lokey | Social Worker | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2020-10-12 |
| 1770190969 | Mallory King | Physician Assistant | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2020-09-30 |
| 1356957161 | Sabrina Star Tovar | Audiologist | 9300 Valley Childrens Pl, Madera, CA 93636-8762 | 2020-09-17 |
| 1790391621 | Alyssa Catherine Nakaguchi | Pharmacist | 9300 Valley Childrens Pl, Madera, CA 93636-8762 | 2020-09-16 |
| 1740894773 | Heather Goossen | Pharmacist | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2020-09-08 |
| 1184236820 | Renzio Menico Bantayan Apostol | Pharmacist | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2020-08-22 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043695257 | Kati Pitts | Social Worker | 9300 Valley Children's Pl., Madera, CA 93636 | 2015-07-29 |
| 1386903177 | Christina Lee-ann Badgett | Registered Nurse | 40617 Rd 406, Madera, CA 93636 | 2012-05-14 |
| 1205134897 | Gina West | Counselor | 10120 Lanes Bridge Dr, Madera, CA 93636 | 2011-03-04 |
| 1326342593 | Re Zaw | Pediatrics | 9300 Valley Children's Place, Residency Dept (ge20), Madera, CA 93636 | 2011-01-03 |
| 1013144179 | Cynthia Romer Fata | Pathology | 9300 Valley Childrens Pl # Sc12, Madera, CA 93636 | 2009-06-16 |
| 1689815888 | Nasser Moiduddin | Pediatrics | 9300 Valley Childrens Pl # PC14, Madera, CA 93636 | 2009-03-18 |
| 1174503338 | James Clifton Horspool | Pediatrics | 9300 Valley Children's Place, Mb01, Madera, CA 93636 | 2006-01-21 |
| 1205818465 | James Weston Hole | Obstetrics & Gynecology | 9300 Valley Children's Pl, Fe16, Madera, CA 93636 | 2005-11-15 |
| 1679056493 | Catherine K. Beaumier | Surgery | 9300 Valley Children's Pl., Madera, CA 93636 | 2018-09-07 |
| 1912492216 | Ji Yeon Kwon | Registered Nurse | 9300 Valley Childrens Pl # Ge07, Madera, CA 93636 | 2018-06-28 |
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| Taxonomy Code | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528579810 | Julia Devi Sharma | Neurological Surgery | 9300 Valley Childrens Pl # Ge07, Madera, CA 93636-8761 | 2017-10-13 |
| 1568821023 | Valley Children's Medical Group - Dept of Neurosurgery | Neurological Surgery | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2016-02-12 |
| 1861798944 | Zachary Wright | Neurological Surgery | 9300 Valley Childrens Pl # Ge07, Madera, CA 93636 | 2011-02-07 |
| 1114107844 | Ashley G Tian | Neurological Surgery | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2007-11-09 |
| 1871642272 | Melandee Brown | Neurological Surgery | 9300 Valley Childrens Pl, Ge07, Madera, CA 93636-8761 | 2007-01-09 |
| 1649206194 | Gary Magram | Neurological Surgery | 9300 Valley Childrens Pl, Children's Hospital Central California, Neurosurgery, Madera, CA 93636-8761 | 2006-06-25 |
| 1245271782 | David S. Knierim | Neurological Surgery | 9300 Valley Childrens Pl, Madera, CA 93638-8761 | 2006-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144477 | Faculty Physicians and Surgeons of Llusm | Neurological Surgery | 35400 Bob Hope Dr Ste 110, Rancho Mirage, CA 92270-1772 | 2020-11-04 |
| 1013524123 | Hubert Tsun-yin Lee | Neurological Surgery | 1201 Welch Road, Stanford, CA 94305-5327 | 2020-09-24 |
| 1811500267 | Chaparral Medical Group, Inc. | Neurological Surgery | 9120 Haven Ave Ste 201, Rancho Cucamonga, CA 91730-5413 | 2020-08-26 |
| 1982259461 | Mauricio Mandel Brigido | Neurological Surgery | 300 Pasteur Dr # R281, Stanford, CA 94305-2200 | 2019-08-01 |
| 1538713227 | Sylvain Palmer Md Inc | Neurological Surgery | 26732 Crown Valley Pkwy Ste 541, Mission Viejo, CA 92691-6376 | 2019-07-31 |
| 1851945877 | X.sean Xin, Do Inc. | Neurological Surgery | 7230 Med Ctr Dr Ste 600, West Hills, CA 91307-4017 | 2019-07-29 |
| 1154974525 | Jan M. Eckermann, Md Inc. | Neurological Surgery | 1617 W Cliff Dr, Ste 203, Newport Beach, CA 92660 | 2019-07-24 |
| 1598317711 | Newport Beach Neurosurgical Institute | Neurological Surgery | 1501 Superior Ave Ste 214b, Newport Beach, CA 92663-3600 | 2019-07-09 |
| 1609438761 | Py26 Neurosurgery, PC | Neurological Surgery | 120 S Spalding Dr Ste 305, Beverly Hills, CA 90212-1800 | 2019-06-28 |
| 1679133664 | Sequoia Neurosurgery, Inc. | Neurological Surgery | 306 N Conyer St Ste A, Visalia, CA 93291-4704 | 2019-06-20 |
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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.