NPIMap

Organization Active NPI

County of Stanislaus

  • Community/Behavioral Health Agency
  • Modesto, CA
National Provider Identifier
1265634281
Registry record updated Sep 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COUNTY OF STANISLAUS
Practice address
190 Hackett Road
Modesto, CA 95358
Phone
(209) 525-6225
NPI assigned
Jun 1, 2007
Organization subpart
Yes
Parent organization
COUNTY OF STANISLAUSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 2, 2020

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

Authorized official

Name
Ruben Imperial, MBA
Title
Behavioral Health Director
Phone
(209) 525-6225

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

190 Hackett Road
Modesto, CA 95358

Mailing address

800 Scenic Dr
Modesto, CA 95350-6131
Phone (209) 525-6225

Other identifiers 1

IdentifierTypeStateIssuer
5040MedicaidCA

Other names 2

  • STANISLAUS COUNTY BEHAVIORAL HEALTH AND RECOVERY SERVICES Doing business as
  • COMMUNITY CORRECTIONS ANNEX FOR MEDICATIONS Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031111000935 CA Part B Supplier - Clinic/Group Practice 0648183996 Receives reassigned benefits from 24 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ceres, CA; Modesto, CA; Turlock, CA
O20031111000939 CA Part B Supplier - Clinic/Group Practice 0648183996 Receives reassigned benefits from 59 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Modesto, CA; Ceres, CA
O20041108000570 CA Part B Supplier - Clinic/Group Practice 0648183996 Receives reassigned benefits from 36 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ceres, CA; Modesto, CA; Turlock, CA

Other NPIs on the same Medicare enrollment 27

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

View all 27

National Provider Directory

National Provider Directory
Part of
Scenic Medical Group

Locations

500 N 9th St
Ste A
Modesto, CA 95350
Phone (209) 525-5300

Practitioners & affiliated clinicians

Practitioners 9

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": "1180656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599004800000",
    "number": "1265634281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SCENIC DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953506131",
            "telephone_number": "209-525-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 HACKETT ROAD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "95358",
            "telephone_number": "209-525-6225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF STANISLAUS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF STANISLAUS",
        "enumeration_date": "2007-06-01",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A",
        "authorized_official_last_name": "IMPERIAL",
        "authorized_official_first_name": "RUBEN",
        "authorized_official_title_or_position": "BEHAVIORAL HEALTH  DIRECTOR",
        "authorized_official_telephone_number": "209-525-6225",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5040",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STANISLAUS COUNTY BEHAVIORAL HEALTH AND RECOVERY SERVICES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "COMMUNITY CORRECTIONS ANNEX FOR MEDICATIONS",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "COMMUNITY CORRECTIONS ANNEX FOR MEDICATIONS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Sep 2, 2020; 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.