Provider Demographics
NPI:1023004850
Name:CONGRESS MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:CONGRESS MEDICAL ASSOCIATES
Other - Org Name:CONGRESS ORTHOPAEDIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRAIPONT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-795-8051
Mailing Address - Street 1:PO BOX 90730
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-0730
Mailing Address - Country:US
Mailing Address - Phone:626-795-8051
Mailing Address - Fax:626-795-0356
Practice Address - Street 1:289 W HUNTINGTON DR STE 103
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3492
Practice Address - Country:US
Practice Address - Phone:626-821-0707
Practice Address - Fax:626-509-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81716207X00000X, 207X00000X
CAA60548207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17086OtherMEDICARE
CAW17086Medicare ID - Type UnspecifiedGROUP ID WITH MEDICARE