Providence Family Practice Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PROVIDENCE FAMILY PRACTICE MEDICAL GROUP

Practice address

1213 Coffee Rd
Suite B
Modesto, CA 95355-4229

Phone

(209) 491-2500

Fax

(209) 491-2545

NPI assigned

Jan 19, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Kathie Lee Cronin, M.D.

Title

Managing Partner

Phone

(209) 491-2500

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Raul Montalvo, M.D.

  • Family Medicine Physician
  • Modesto, CA
  • NPI 1518967488
  NPD (past)

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104979582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1213 COFFEE RD",
            "address_2": "SUITE B",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554229",
            "telephone_number": "209-491-2500",
            "fax_number": "209-491-2545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 COFFEE RD",
            "address_2": "SUITE B",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554229",
            "telephone_number": "209-491-2500",
            "fax_number": "209-491-2545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE FAMILY PRACTICE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CRONIN",
        "authorized_official_first_name": "KATHIE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "209-491-2500",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Van Sieng Prom, D.C
• Lindsey Provencher, PCCI
• Joseph Johnny Provenzano Jr., DO
• Proveri Ventures LLC
• Proveri Ventures LLC
• Provident Care
• Provident Senior Solutions, Inc.
• Samantha Pruitt, CADC II, ICADC
• Caryl Prunty
• Donna Lynn Pryor, PA-C

• Family Medicine Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.