NPIMap

Individual provider Active NPI

Terry Lee Croasdale, M.D.

  • Internal Medicine Physician
  • Manteca, CA
National Provider Identifier
1295713147
Registry record updated Apr 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C43012 Issued in CA
Practice address
1262 E North St
Manteca, CA 95336-4962
Phone
(209) 823-7646
Fax
(209) 239-9594
NPI assigned
Jan 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X C43012 CA Primary

Addresses

Primary practice location

1262 E North St
Manteca, CA 95336-4962

Mailing address

1262 E North St
Manteca, CA 95336-4962
Phone (209) 823-7646

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
I20050418001179 CA Practitioner - Internal Medicine 2163460460 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Missouri, Columbia School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shane Speirs MD PCGroup PAC ID 1355875741, 14 clinicians

Practice addresses (Care Compare)

1262 E N St
Suite 100
Manteca, CA 95336-4962
Phone (209) 823-7646

Hospital & facility affiliations

  • Ameriprime Home Health Care Home health agency, Tracy, CA, CCN 757096
  • Careone Home Health and Hospice, Inc Home health agency, Salida, CA, CCN 059401
  • Sky Healthcare Home Health Services Home health agency, Pleasanton, CA, CCN 559446
  • Doctors Hospital of Manteca Hospital, Manteca, CA, CCN 050118
  • Memorial Medical Center Hospital, Modesto, CA, CCN 050557
  • St Joseph'S Medical Center of Stockton Hospital, Stockton, CA, CCN 050084
  • Sutter Tracy Community Hospital Hospital, Tracy, CA, CCN 050313

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
64.37
Promoting interoperability
100
Improvement activities
40
Cost
72.88

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43012CAMDDentist
C43012CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
First Choice Physician Partners Current Accepting new patients
Shane Speirs MD PC CurrentSince Dec 6, 2024 Accepting new patients
First Choice Physician Partners CurrentSince Sep 23, 2018 Accepting new patients
First Choice Physician Partners CurrentSince Sep 23, 2018 Accepting new patients

Locations

1262 E North St
Manteca, CA 95336
Phone (209) 823-7646

1234 E North St
Ste 103
Manteca, CA 95336
Phone (209) 647-3101

1262 E North St
Ste 100
Manteca, CA 95336
Phone (209) 524-1668

1444 Florida Ave
Ste 100
Modesto, CA 95350
Phone (209) 524-1668

1541 Florida Ave
Modesto, CA 95350
Phone (209) 214-7049

1441 Florida Ave
Modesto, CA 95350
Phone (209) 214-7235

1444 Florida Ave
Ste 1
Modesto, CA 95350

1444 Florida Ave
Ste 12
Modesto, CA 95350
Phone (209) 524-1264

35800 Bob Hope Dr
Ste 225
Rancho Mirage, CA 92270
Phone (760) 324-4466

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: terry.croasdale.1@24378.direct.athenahealth.com
  • Direct secure messaging: terry.croasdale@843.chartlogic.direct-ci.com

Organizations & group practices 4

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 7

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": "1136073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270771200000",
    "number": "1295713147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1262 E NORTH ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953364962",
            "telephone_number": "209-823-7646",
            "fax_number": "209-239-9594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1262 E NORTH ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953364962",
            "telephone_number": "209-823-7646",
            "fax_number": "209-239-9594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROASDALE",
        "first_name": "TERRY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-01",
        "last_updated": "2010-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C43012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manteca, CA

Sources for this page

Verify at the official NPI Registry.