NPIMap

Organization Active NPI

Gettysburg Medical Clinic Inc

  • Primary Care Clinic/Center
  • Modesto, CA
National Provider Identifier
1033580931
Registry record updated Oct 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
GETTYSBURG MEDICAL CLINIC INC
Practice address
1130 Coffee Rd
Building 10
Modesto, CA 95355-4228
Phone
(209) 725-2060
Fax
(209) 725-2072
NPI assigned
Oct 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Grace Wee Lim, M.D.NPI 1437256211
Title
President
Phone
(209) 725-2060

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1130 Coffee Rd
Building 10
Modesto, CA 95355-4228

Mailing address

PO Box 26180
Fresno, CA 93729-6180
Phone (209) 725-2060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121128000353 CA Part B Supplier - Clinic/Group Practice 5991957805 Receives reassigned benefits from 5 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Modesto, CA; Merced, CA; Fresno, CA; Atwater, CA

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Gettysburg Medical Clinic8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1445126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445126400000",
    "number": "1033580931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26180",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937296180",
            "telephone_number": "209-725-2060",
            "fax_number": "209-725-2072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 COFFEE RD",
            "address_2": "BUILDING 10",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554228",
            "telephone_number": "209-725-2060",
            "fax_number": "209-725-2072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GETTYSBURG MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-18",
        "last_updated": "2015-10-18",
        "status": "A",
        "authorized_official_last_name": "LIM",
        "authorized_official_first_name": "GRACE",
        "authorized_official_middle_name": "WEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-725-2060",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.