Individual provider Active NPI

Robert Craig Fetz, M.D.

  • Diagnostic Radiology Physician
  • Modesto, CA
National Provider Identifier
1306869177
Registry record updated Aug 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
G33114 Issued in CA
Practice address
1524 McHenry Ave
Suite 100
Modesto, CA 95350-4500
Phone
(209) 577-4444
Fax
(209) 527-2069
NPI assigned
Jul 25, 2006
Last updated
Aug 27, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X G33114 CA Primary

Addresses

Primary practice location

1524 McHenry Ave
Suite 100
Modesto, CA 95350-4500

Mailing address

101 Park Ave
Modesto, CA 95354-0556
Phone (209) 571-6622

Other identifiers 1

IdentifierTypeStateIssuer
00G331140MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080605000888 CA Practitioner - Diagnostic Radiology 0042108086 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Loyola University of Chicago, Stritch School of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7031 Crane Rd
Oakdale, CA 95361-8039
Phone (209) 576-3766

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40
Cost
84.14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G33114CAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
San Joaquin Faculty Medical Group CurrentSince Jul 6, 2019 Accepting new patients
County of San Joaquin CurrentSince Jul 6, 2019 Accepting new patients
County of San Joaquin CurrentSince Jul 6, 2019 Accepting new patients
Modesto Radiological Medical Group, Inc Diagnostic Radiology CurrentSince Sep 23, 2021 Accepting new patients
Modesto Radiological Medical Group, Inc. Diagnostic Radiology CurrentSince Sep 23, 2021 Accepting new patients
Ronald Johanson, Thomas Wilson, James Maclaren PTRS Past Accepting new patients

Locations

500 W Hospital Rd
French Camp, CA 95231
Phone (209) 468-6000

581 4th Ave
Gustine, CA 95322
Phone (209) 854-1120

101 Park Ave
Modesto, CA 95354
Phone (209) 491-0872

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

1444 Florida Ave
Ste 101
Modesto, CA 95350
Phone (209) 522-1027

1524 McHenry Ave
Ste 100
Modesto, CA 95350
Phone (209) 571-6622

1524 McHenry Ave
Ste 420
Modesto, CA 95350
Phone (209) 522-2877

1524 McHenry Ave
Ste 430
Modesto, CA 95350
Phone (301) 676-5825

1700 Coffee Rd
Modesto, CA 95355
Phone (209) 526-4500

350 S Oak Ave
Oakdale, CA 95361
Phone (209) 847-3011

1801 Colorado Ave
Ste 240
Turlock, CA 95382
Phone (209) 216-3400

2121 Colorado Ave
Turlock, CA 95382
Phone (209) 664-2520

3900 Geer Rd
Turlock, CA 95382
Phone (209) 669-0600

3900 Geer Rd
#1112
Turlock, CA 95382
Phone (209) 669-0600

911 E Tuolumne Rd
Turlock, CA 95382
Phone (209) 668-4101

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219795200000",
    "number": "1306869177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PARK AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953540556",
            "telephone_number": "209-571-6622",
            "fax_number": "209-527-2069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1524 MCHENRY AVE",
            "address_2": "SUITE 100",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504500",
            "telephone_number": "209-577-4444",
            "fax_number": "209-527-2069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETZ",
        "first_name": "ROBERT",
        "middle_name": "CRAIG",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2008-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G33114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G331140",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.