NPIMap

Organization Active NPI

Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Modesto, CA
National Provider Identifier
1295719813
Registry record updated Feb 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
030000757 Issued in CA
Legal business name
GOLDEN VALLEY HEALTH CENTER
Practice address
1130 6TH St
Modesto, CA 95354-2203
Phone
(209) 491-5550
Fax
(209) 491-5468
NPI assigned
Dec 6, 2005
Last updated
Feb 9, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2017

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

Authorized official

Name
Mr. Tony Weber
Title
Ceo
Phone
(209) 384-6493

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 030000757 CA Primary

Addresses

Primary practice location

1130 6TH St
Modesto, CA 95354-2203

Mailing address

737 W Childs Ave
Merced, CA 95341-6805
Phone (209) 384-6493

Other identifiers 2

IdentifierTypeStateIssuer
030000757OtherCASTATE OF CA LIC#
CMM70889FMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040128000641 CA Part B Supplier - Clinic/Group Practice 4183527187 Receives reassigned benefits from 494 practitioners
45 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Modesto, CA; Manteca, CA; Newman, CA; Patterson, CA; Planada, CA; Riverbank, CA; Turlock, CA; Westley, CA…

Other NPIs on the same Medicare enrollment 45

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

View all 45

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486598400000",
    "number": "1295719813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 W CHILDS AVE",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953416805",
            "telephone_number": "209-384-6493",
            "fax_number": "209-383-1296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 6TH ST",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953542203",
            "telephone_number": "209-491-5550",
            "fax_number": "209-491-5468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN VALLEY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-06",
        "last_updated": "2017-02-09",
        "status": "A",
        "authorized_official_last_name": "WEBER",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-384-6493",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "030000757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF CA LIC#",
            "identifier": "030000757",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70889F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Feb 9, 2017; 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.