Modesto Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G68634 Issued in CA

Legal business name

MODESTO PEDIATRICS

Practice address

3109 Coffee Rd
Ste a
Modesto, CA 95355-1766

Phone

(209) 522-0001

Fax

(209) 549-7077

NPI assigned

Sep 13, 2006

Organization subpart

No

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

Authorized official

Name

Ann Marie Truscello, MDNPI 1437120532

Title

President

Phone

(209) 522-0001

Specialties & licenses 2

Addresses

Other identifiers 2

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

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ann Marie Truscello, MD

  • Pediatrics Physician
  • Modesto, CA
  • NPI 1437120532

  Pediatrics

  NPD (past) Authorized official
• Dena Ann Lenser, MD

  • Pediatrics Physician
  • Modesto, CA
  • NPI 1245201599

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313452800000",
    "number": "1366547796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 578202",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953578202",
            "telephone_number": "209-522-0001",
            "fax_number": "209-549-7077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3109 COFFEE RD",
            "address_2": "STE A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551766",
            "telephone_number": "209-522-0001",
            "fax_number": "209-549-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODESTO PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2011-08-16",
        "status": "A",
        "authorized_official_last_name": "TRUSCELLO",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-522-0001",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G68634",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G83542",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0094690",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP PIN",
            "identifier": "ZZZ07358Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Modesto on-Call Services, LLC
• Modesto Optometric Vision Center Inc a Professional Optometric Corp
• Modesto Orthopedic Group
• Modesto Orthopedic Medical Group
• Modesto Pain Diagnostic Treatment Center
• Modesto Physical Therapy
• Modesto Primary Care
• Modesto Radiological Medical Group, Inc.
• Modesto Radiology Imaging, Inc.
• Modesto Residential Living Center

• All providers in Modesto, CA
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.