Modesto Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

030000552 Issued in CA

Legal business name

MODESTO SURGERY CENTER LLC

Practice address

400 E Orangeburg Ave Ste 1
Modesto, CA 95350-5342

Phone

(209) 526-3000

Fax

(209) 526-3133

NPI assigned

Apr 4, 2007

Last updated

Dec 28, 2021By 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

Cheryl Elaine Bonelli

Title

Corporate Administrator

Phone

(760) 685-4096

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Modesto Surgery Center IncCCN 05C0001324

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Modesto Surgery Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Modesto Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Modesto, CA
  • NPI 1346287232
  NPD tax ID

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Navani Pain Management Inc.

  dba Comprehensive Pain Management Inc.

  • Pain Medicine Physician
  • Campbell, CA
  • NPI 1437339686

  Member Of

  NPD member
• Stevens Kim MD and Stephen Lin MD Medical Group Inc

  dba Valley Laser Surgery Center, Inc.

  • Ambulatory Surgical Clinic/Center
  • Stockton, CA
  • NPI 1669540118

  Member Of

  NPD member

Locations

Practitioners 3

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.

• Freddie D McClendon, MD

  • Anesthesiology Physician
  • Bakersfield, CA
  • NPI 1942256722
  NPD (past)
• Gregory Clifton Tesluk, MD

  • Ophthalmology Physician
  • Modesto, CA
  • NPI 1255351755
  NPD (past)
• Margaret Tesluk, CRNA

  • Registered Nurse
  • Modesto, CA
  • NPI 1275688194
  NPD (past)

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640649600000",
    "number": "1356463913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E ORANGEBURG AVE STE 1",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953505342",
            "telephone_number": "209-526-3000",
            "fax_number": "209-526-3133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E ORANGEBURG AVE STE 1",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953505342",
            "telephone_number": "209-526-3000",
            "fax_number": "209-526-3133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODESTO SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A",
        "authorized_official_last_name": "BONELLI",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "CORPORATE ADMINISTRATOR",
        "authorized_official_telephone_number": "760-685-4096"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "030000552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SUR01324F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Modesto Residential Living Center
• Modesto Senior Living Limited Partnership (Sundial Senior Living Community)
• Modesto SNF Operations LLC (Golden Modesto Care Center)
• Modesto Specialty Surgery Center, PC
• Modesto Surgery Center
• Modesto Surgical Associates
• Modesto Urgent Care Inc
• Modi Dental Corporation
• Jenil Modi, MD
• Priti Tushar Modi, M.D., F.A.C.P.

• Ambulatory Surgical Clinic/Center in Modesto, CA
• Providers in Modesto, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; 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.