NPI |
1154983187 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Last Name Legal Name |
BONY |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
ALEXANDER |
The first name of the provider, if the provider
is an individual. |
Provider Middle Name |
STAVROS |
The middle name of the provider, if the provider
is an individual. |
Provider First Line Business Practice Location Address |
5320 HIGHWAY 49 N STE 4 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
MARIPOSA |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
CA |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
953389588 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
5596832084 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
2093174020 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
6/29/2019 |
The middle name of the provider, if the provider
is an individual. |
Last Update Date |
8/11/2020 |
The date that a record was last updated or changed. |
Provider Gender Code |
M |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
101Y00000X |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider License Number State Code 1 |
CA |
The city name in the location address of the provider being identified. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Healthcare Provider Taxonomy Code 2 |
390200000X |
|
Healthcare Provider Primary Taxonomy Switch 2 |
N |
|
Is Sole Proprietor |
N |
The date the provider was assigned a unique identifier (assigned an NPI). |
NPI Certification Date |
8/11/2020 |
|