NPIMap

Organization Active NPI

Manteca Medical Group, Inc

  • Internal Medicine Physician
  • Manteca, CA
National Provider Identifier
1437113065
Registry record updated Apr 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C43012 Issued in CA
Legal business name
MANTECA MEDICAL GROUP, INC
Practice address
1262 E North St
Manteca, CA 95336-4962
Phone
(209) 823-7646
Fax
(209) 824-5374
NPI assigned
Apr 12, 2006
Last updated
Apr 9, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2010

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

Authorized official

Name
Dr. Terry Croasdale, M.D.NPI 1295713147
Title
Cfo/Coo
Phone
(209) 823-7646

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A24460 CA
Internal Medicine Physician 207R00000X A54203 CA
Internal Medicine Physician 207R00000X C43012 CA Primary
Obstetrics & Gynecology Physician 207V00000X 20A7379 CA
Obstetrics & Gynecology Physician 207V00000X G55402 CA
Pediatrics Physician 208000000X A51139 CA
Pediatrics Physician 208000000X A50060 CA

Addresses

Primary practice location

1262 E North St
Manteca, CA 95336-4962

Mailing address

1262 E North St
Manteca, CA 95336-4962
Phone (209) 823-7646

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270771200000",
    "number": "1437113065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1262 E NORTH ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953364962",
            "telephone_number": "209-823-7646",
            "fax_number": "209-824-5374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1262 E NORTH ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953364962",
            "telephone_number": "209-823-7646",
            "fax_number": "209-824-5374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANTECA MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-12",
        "last_updated": "2010-04-09",
        "status": "A",
        "authorized_official_last_name": "CROASDALE",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "CFO/COO",
        "authorized_official_telephone_number": "209-823-7646",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A24460",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A54203",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C43012",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "20A7379",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "G55402",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A51139",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A50060",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manteca, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2010; 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.