NPIMap

Individual provider Active NPI

Steven Peretiatko, MD

  • Physical Medicine & Rehabilitation Physician
  • Modesto, CA
National Provider Identifier
1053871491
Registry record updated Nov 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
A190660 Issued in CA
Practice address
1303 Mable Ave
Modesto, CA 95355-1119
Phone
(209) 857-3400
Fax
(818) 671-2225
NPI assigned
Mar 21, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X A190660 CA Primary

Addresses

Primary practice location

1303 Mable Ave
Modesto, CA 95355-1119

Mailing address

PO Box 872
Agoura Hills, CA 91376-0872
Phone (818) 518-7226

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240111003948 CA Practitioner - Physical Medicine and Rehabilitation 9032446018 Reassigns benefits to 2 organizations
Practice locations: Modesto, CA

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
University of Florida College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Norcal Pain Treatment Center CorpGroup PAC ID 5698007086, 9 clinicians

Practice addresses (Care Compare)

1303 Mable Ave
Modesto, CA 95355-1119
Phone (818) 518-7226

1739 Colorado Ave
Turlock, CA 95382-2714
Phone (209) 448-3000

Hospital & facility affiliations

  • Memorial Medical Center Hospital, Modesto, CA, CCN 050557
  • Adventist Health Sonora Hospital, Sonora, CA, CCN 050335
  • Doctors Medical Center Hospital, Modesto, CA, CCN 050464

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A190660CAMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Norcal Pain Treatment Center Corp. CurrentSince Sep 3, 2024 Accepting new patients
Norcal Pain Treatment Center Corp CurrentSince Sep 3, 2024 Accepting new patients
Steven Peretiatko MD a Medical Corporation Physical Medicine & Rehabilitation CurrentSince Mar 20, 2024 Accepting new patients

Locations

1117 W Tokay St
Ste A
Lodi, CA 95240
Phone (209) 333-2551

123 W North Bear Creek Dr
Merced, CA 95348
Phone (209) 448-3000

1303 Mable Ave
Modesto, CA 95355
Phone (209) 232-4350

1801 Colorado Ave
Ste 200
Turlock, CA 95382
Phone (209) 448-3000

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: steven.peretitako@3441.securemail.prognocis.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1553126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731628800000",
    "number": "1053871491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 872",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913760872",
            "telephone_number": "818-518-7226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 MABLE AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551119",
            "telephone_number": "209-857-3400",
            "fax_number": "818-671-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERETIATKO",
        "first_name": "STEVEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-21",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "A190660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.