Mahesh G Modi, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

A37333 Issued in CA

Practice address

2160 W Grant Line Rd
Suite 240
Tracy, CA 95377-7330

Phone

(209) 833-6118

Fax

(209) 835-7999

NPI assigned

Jan 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263945600000",
    "number": "1376514489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 986",
            "city": "WOODBRIDGE",
            "state": "CA",
            "postal_code": "952580986",
            "telephone_number": "209-339-9036",
            "fax_number": "209-339-1901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 W GRANT LINE RD",
            "address_2": "SUITE 240",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953777330",
            "telephone_number": "209-833-6118",
            "fax_number": "209-835-7999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODI",
        "first_name": "MAHESH",
        "middle_name": "G",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-27",
        "last_updated": "2010-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A37333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A373330",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Tracy, CA
• Providers in Tracy, CA by specialty
• Gastroenterology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.