Modesto Kidney Medical Group

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

01031187 02 Issued in CA

Legal business name

MODESTO KIDNEY MEDICAL GROUP

Practice address

305 E Granger Ave
Ste 202
Modesto, CA 95350-4344

Phone

(209) 526-1606

Fax

(209) 526-1677

NPI assigned

Jun 1, 2005

Last updated

Mar 29, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lori D Meischke

Title

Billing Manager

Phone

(541) 706-9073

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Itsara and Liu MD's Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 9

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.

• Han-Cheng Chen

  • Internal Medicine Physician
  • San Francisco, CA
  • NPI 1912387796
  Medicare reassignment Care Compare group NPD
• Yuqiang Ge, M.D., PHD

  • Nephrology Physician
  • Modesto, CA
  • NPI 1740588680
  Medicare reassignment Care Compare group NPD
• Chang S Joo, MD

  • Nephrology Physician
  • Modesto, CA
  • NPI 1508868787
  Medicare reassignment Care Compare group NPD
• Tong Sun, MD

  • Nephrology Physician
  • Modesto, CA
  • NPI 1629161336
  Medicare reassignment Care Compare group NPD
• Kenneth K Liu, MD

  • Nephrology Physician
  • Modesto, CA
  • NPI 1326042391
  Medicare reassignment NPD
• Keith A. Leibowitz, MD

  • Gastroenterology Physician
  • Modesto, CA
  • NPI 1083689335
  NPD
• Gurpreet Singh, MD

  • Gastroenterology Physician
  • Turlock, CA
  • NPI 1194780999
  NPD
• Mark T Fahlen, MD

  • Nephrology Physician
  • Modesto, CA
  • NPI 1679539415
  NPD (past)
• Sithu Lin, M.D.

  • Nephrology Physician
  • Fountain Valley, CA
  • NPI 1023417649
  NPD (past)

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364515200000",
    "number": "1306848569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 E GRANGER AVE",
            "address_2": "SUITE 202",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504345",
            "telephone_number": "209-526-1606",
            "fax_number": "209-526-1677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 E GRANGER AVE",
            "address_2": "STE 202",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504344",
            "telephone_number": "209-526-1606",
            "fax_number": "209-526-1677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODESTO KIDNEY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-01",
        "last_updated": "2013-03-29",
        "status": "A",
        "authorized_official_last_name": "MEISCHKE",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "541-706-9073"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "01031187 02",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0026660",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Itsara and Liu MD's",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Modesto Gastroenterology Medical Corporation
• Modesto Gospel Mission
• Modesto Hearing Aid Center
• Modesto Kidney Center, Inc.
• Modesto Kidney Center, LLC (U.S. Renal Care Modesto Dialysis)
• Modesto Mental Health Consultants Inc a Professional Medical Corp
• Modesto Mobility Center Inc.
• Modesto Natural Birth Place
• Modesto Neonatal Medical Group, Inc.
• Modesto on-Call Services, LLC

• Nephrology Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.