NPIMap

Individual provider Active NPI

Chang S Joo, MD

  • Nephrology Physician
  • Modesto, CA
National Provider Identifier
1508868787
Registry record updated Feb 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A481920 Issued in CA
Practice address
305 E Granger Ave
Ste 202
Modesto, CA 95350-4344
Phone
(209) 526-1606
Fax
(209) 526-1677
NPI assigned
Jun 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A481920 CA Primary

Addresses

Primary practice location

305 E Granger Ave
Ste 202
Modesto, CA 95350-4344

Mailing address

305 E Granger Ave
Ste 202
Modesto, CA 95350-4344
Phone (209) 526-1606

Other identifiers 1

IdentifierTypeStateIssuer
00A481920MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040908000852 CA Practitioner - NephrologyPractitioner - Internal Medicine 6507832201 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Modesto Kidney Medical GroupGroup PAC ID 1052395795, 4 clinicians

Practice addresses (Care Compare)

305 E Granger Ave
Suite 202
Modesto, CA 95350-4344
Phone (209) 526-1606

Hospital & facility affiliations

  • Usrc Modesto Dialysis Dialysis facility, Modesto, CA, CCN 052783
  • DaVita Archway Dialysis of Modesto Dialysis facility, Modesto, CA, CCN 552760
  • SHC Turlock Dialysis facility, Turlock, CA, CCN 052647
  • Usrc Parkway Dialysis facility, Modesto, CA, CCN 052888
  • Usrc Oakdale Dialysis facility, Oakdale, CA, CCN 052853
  • Doctors Medical Center Hospital, Modesto, CA, CCN 050464
  • Memorial Medical Center Hospital, Modesto, CA, CCN 050557
  • Emanuel Medical Center Hospital, Turlock, CA, CCN 050179
  • Oak Valley Hospital District Hospital, Oakdale, CA, CCN 050067

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
48192CAMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
A481920CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Modesto Kidney Medical Group Nephrology CurrentSince Apr 1, 1987 Accepting new patients
Emanuel Medical Center, Inc. Past Accepting new patients
Oakdale Kidney Center LLC PastSince Dec 1, 2010 Accepting new patients
Sutter Valley Hospitals Past Accepting new patients

Locations

305 E Granger Ave
Ste 202
Modesto, CA 95350
Phone (209) 526-1606

1700 Keystone Pacific Pkwy
Unit A2
Patterson, CA 95363
Phone (209) 526-1606

981 E Tuolumne Rd
Ste 108
Turlock, CA 95382
Phone (209) 522-6100

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: csj105pcs@m1160.primeclinicalsystems.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203638400000",
    "number": "1508868787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 E GRANGER AVE",
            "address_2": "STE 202",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504344",
            "telephone_number": "209-526-1606",
            "fax_number": "209-526-1677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 E GRANGER AVE",
            "address_2": "STE 202",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504344",
            "telephone_number": "209-526-1606",
            "fax_number": "209-526-1677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOO",
        "first_name": "CHANG",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2008-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A481920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A481920",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.