NPIMap

Individual provider Active NPI

Andrew Modic, MD

  • Internal Medicine Physician
  • Ridgecrest, CA
National Provider Identifier
1063831972
Registry record updated Feb 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A155740 Issued in CA
Practice address
1111 N China Lake Blvd
Ridgecrest, CA 93555-3131
Phone
(760) 499-3855
Fax
(760) 499-3870
NPI assigned
Apr 8, 2014
Last updated
Feb 12, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD.34762 AL
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X A155740 CA Primary

Addresses

Primary practice location

1111 N China Lake Blvd
Ridgecrest, CA 93555-3131

Mailing address

1081 N China Lake Blvd
Ridgecrest, CA 93555-3130
Phone (760) 499-3855

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190306000897 CA Practitioner - Pediatric MedicinePractitioner - Internal Medicine 4688993322 Reassigns benefits to 1 organization
I20210212000128 TX Practitioner - Internal Medicine 4688993322 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Connecticut School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ridgecrest Regional HospitalGroup PAC ID 9739099896, shared by 9 NPIs, 94 clinicians

Practice addresses (Care Compare)

1011 N China Lake Blvd
Ridgecrest, CA 93555-3130
Phone (760) 446-6404

1081 N China Lake Blvd
Ridgecrest, CA 93555-3130
Phone (760) 499-3899

1111 N China Lake Blvd
Ridgecrest, CA 93555-3131
Phone (760) 499-3855

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.34762ALMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Ridge Indian Health Service Hospital CurrentSince Jan 20, 2021 Accepting new patients
Pine Ridge Indian Health Service Hospital Current Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Jan 20, 2021 Accepting new patients
Ridgecrest Regional Hospital Internal Medicine Past Accepting new patients

Organizations & group practices 5

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

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1396915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549929600000",
    "number": "1063831972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1081 N CHINA LAKE BLVD",
            "city": "RIDGECREST",
            "state": "CA",
            "postal_code": "935553130",
            "telephone_number": "760-499-3855",
            "fax_number": "760-499-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 N CHINA LAKE BLVD",
            "city": "RIDGECREST",
            "state": "CA",
            "postal_code": "935553131",
            "telephone_number": "760-499-3855",
            "fax_number": "760-499-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODIC",
        "first_name": "ANDREW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-08",
        "last_updated": "2019-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "MD.34762",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A155740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgecrest, CA

Sources for this page

Verify at the official NPI Registry.