NPIMap

Organization Active NPI

Yosemite Pathology Medical Group, Inc

  • Anatomic Pathology & Clinical Pathology Physician
  • Modesto, CA
National Provider Identifier
1598760985
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
C32684 Issued in CA
Legal business name
YOSEMITE PATHOLOGY MEDICAL GROUP, INC
Practice address
4301 N Star Way
Modesto, CA 95356-9262
Phone
(209) 577-1200
Fax
(209) 577-6517
NPI assigned
Jun 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

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

Authorized official

Name
Jennifer Pinasco
Title
Delegated Official
Phone
(209) 577-1200

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZC0500X C32684 CA
Dermatopathology (Pathology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZD0900X C32684 CA
Forensic Pathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZF0201X C32684 CA
Immunopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZI0100X C32684 CA
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0102X C32684 CA Primary

Addresses

Primary practice location

4301 N Star Way
Modesto, CA 95356-9262

Mailing address

PO Box 576768
Modesto, CA 95357-6768
Phone (209) 577-1200

Other identifiers 9

IdentifierTypeStateIssuer
690005510OtherCARAILROAD LAB
CP5083OtherCARAILROAD MEDICARE
GR0017740MedicaidCA
GR0017745MedicaidCA
GR0017742MedicaidCA
GR001774AMedicaidCA
GR0017741MedicaidCA
GR0017748MedicaidCA
GR0017744MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040217000597 CA Part B Supplier - Clinic/Group Practice 3072415751 Receives reassigned benefits from 77 practitioners
Practice locations: Oakdale, CA; Turlock, CA; Tracy, CA; Stockton, CA; Sonora, CA; San Andreas, CA; Modesto, CA; Merced, CA…

National Provider Directory

National Provider Directory
Tax ID family
Yosemite Path Med GRP I9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Locations

730 17th St
Modesto, CA 95354
Phone (209) 248-7700

4301 N Star Way
Ste A
Modesto, CA 95356

2625 Coffee Rd
Modesto, CA 95355

Practitioners & affiliated clinicians

Practitioners 94

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

View all 94

NPI Registry JSON

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725840000000",
    "number": "1598760985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 576768",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953576768",
            "telephone_number": "209-577-1200",
            "fax_number": "209-577-6517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 N STAR WAY",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569262",
            "telephone_number": "209-577-1200",
            "fax_number": "209-577-6517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOSEMITE PATHOLOGY MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-14",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A",
        "authorized_official_last_name": "PINASCO",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "209-577-1200"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Cytopathology",
            "state": "CA",
            "license": "C32684",
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Dermatopathology",
            "state": "CA",
            "license": "C32684",
            "primary": false
        },
        {
            "code": "207ZF0201X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Forensic Pathology",
            "state": "CA",
            "license": "C32684",
            "primary": false
        },
        {
            "code": "207ZI0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Immunopathology",
            "state": "CA",
            "license": "C32684",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "C32684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD LAB",
            "identifier": "690005510",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CP5083",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0017740",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0017745",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0017742",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR001774A",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0017741",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0017748",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0017744",
            "state": "CA"
        }
    ],
    "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 Sep 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.