Individual provider Active NPI

Greg Anthony Vigna, MD

  • Physical Medicine & Rehabilitation Physician
  • Modesto, CA
National Provider Identifier
1376514190
Registry record updated Mar 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
C54741 Issued in CA
Practice address
1303 Mable Ave
Modesto, CA 95355-0001
Phone
(209) 857-3400
Fax
(805) 564-3332
NPI assigned
Jan 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2022

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 1469 SD
Physical Medicine & Rehabilitation Physician 208100000X 01075520A IN
Physical Medicine & Rehabilitation Physician 208100000X 35141611 OH
Physical Medicine & Rehabilitation Physician 208100000X C54741 CA Primary
Physical Medicine & Rehabilitation Physician 208100000X 85785 MT

Addresses

Primary practice location

1303 Mable Ave
Modesto, CA 95355-0001

Mailing address

PO Box 50706
Santa Barbara, CA 93150-0706
Phone (805) 963-3757

Other practice location 1

500 15th Ave S
Great Falls, MT 59405-4324
Phone (406) 731-8888

Other identifiers 1

IdentifierTypeStateIssuer
201299460MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
54741CAMDGeneral Practice Dentistry
C54741CAMDPhysical Medicine & Rehabilitation Physician
85785MTMDPhysical Medicine & Rehabilitation Physician
35141611OHMDPhysical Medicine & Rehabilitation Physician
1469SDMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Major Hospital Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648166400000",
    "number": "1376514190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50706",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "931500706",
            "telephone_number": "805-963-3757",
            "fax_number": "805-564-3332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 MABLE AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953550001",
            "telephone_number": "209-857-3400",
            "fax_number": "805-564-3332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 15th Ave S",
            "address_purpose": "LOCATION",
            "city": "Great Falls",
            "state": "MT",
            "postal_code": "594054324",
            "country_code": "US",
            "telephone_number": "406-731-8888",
            "fax_number": "406-731-8318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIGNA",
        "first_name": "GREG",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "SD",
            "license": "1469",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IN",
            "license": "01075520A",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "OH",
            "license": "35141611",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "C54741",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MT",
            "license": "85785",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201299460",
            "state": "IN"
        }
    ],
    "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 Mar 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.