NPIMap

Organization Active NPI

Vitreo-Retinal Medical Group, Inc.

  • Retina Specialist (Ophthalmology) Physician
  • Modesto, CA
National Provider Identifier
1114010949
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
VITREO-RETINAL MEDICAL GROUP, INC.
Practice address
4712 Stoddard Rd
Modesto, CA 95356-9404
Phone
(209) 549-8444
Fax
(209) 549-8443
NPI assigned
Oct 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

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

Authorized official

Name
Dr. Joel Pearlman, MDNPI 1154430460
Title
President
Phone
(916) 596-2027

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207WX0107X Primary

Addresses

Primary practice location

4712 Stoddard Rd
Modesto, CA 95356-9404

Mailing address

3 Park Center Dr Ste 210
Sacramento, CA 95825-8341
Phone (916) 596-2027

Other practice location 1

1401 Spanos Ct Ste 124
Modesto, CA 95355-2814
Phone (209) 549-8444

Other practice location 2

1401 Spanos Ct
Suite 223
Modesto, CA 95355-2810
Phone (209) 549-8444

Other identifiers 5

IdentifierTypeStateIssuer
CP5300OtherCARAILROAD MEDICARE
ZZZ32011ZOtherCAWORKERS COMP
0199873OtherWADEPT. OF LABOR WA
GR0030323MedicaidCA
ZZZ29020ZOtherCABLUE SHIELD CA

Other names 1

  • Modesto Retina Center, Inc. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050427000951 CA Part B Supplier - Clinic/Group Practice 5799672275 Receives reassigned benefits from 23 practitioners
16 other NPIs on this enrollment
Practice locations: Yuba City, CA; Tracy, CA; Fairfield, CA; Stockton, CA; Sacramento, CA; Roseville, CA; Merced, CA; Grass Valley, CA…

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Retinal Cons of Sacto12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

4712 Stoddard Rd
Modesto, CA 95356
Phone (209) 549-8444

5771 Greenback Ln
Sacramento, CA 95841
Phone (916) 239-2042

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1114010949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 PARK CENTER DR STE 210",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958258341",
            "telephone_number": "916-596-2027",
            "fax_number": "866-913-6557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4712 STODDARD RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569404",
            "telephone_number": "209-549-8444",
            "fax_number": "209-549-8443"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1401 Spanos Ct Ste 124",
            "address_purpose": "LOCATION",
            "city": "Modesto",
            "state": "CA",
            "postal_code": "953552814",
            "country_code": "US",
            "telephone_number": "209-549-8444",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1401 Spanos Ct",
            "address_2": "Suite 223",
            "address_purpose": "LOCATION",
            "city": "Modesto",
            "state": "CA",
            "postal_code": "953552810",
            "country_code": "US",
            "telephone_number": "209-549-8444",
            "fax_number": "209-549-8443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VITREO-RETINAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A",
        "authorized_official_last_name": "PEARLMAN",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-596-2027",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CP5300",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMP",
            "identifier": "ZZZ32011Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT. OF LABOR WA",
            "identifier": "0199873",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030323",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD CA",
            "identifier": "ZZZ29020Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modesto Retina Center, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Modesto Retina Center, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 6, 2023; 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.