NPIMap

Organization Active NPI

County of Stanislaus

Doing business as Stanislaus County Health Services Agency

  • Multi-Specialty Clinic/Center
  • Modesto, CA
National Provider Identifier
1629094891
Registry record updated Oct 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
COUNTY OF STANISLAUS
Doing business as
Stanislaus County Health Services Agency
Practice address
830 Scenic Dr
Modesto, Ca Suite B
Modesto, CA 95350-6131
Phone
(209) 558-7000
Fax
(209) 558-8611
NPI assigned
Jul 14, 2006
Last updated
Oct 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2024

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

Authorized official

Name
Mary Ann Lee
Title
Managing Director
Phone
(209) 558-7163

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

830 Scenic Dr
Modesto, Ca Suite B
Modesto, CA 95350-6131

Mailing address

830 Scenic Dr
Modesto, Ca Suite B
Modesto, CA 95350-6131
Phone (209) 558-7000

Other identifiers 15

IdentifierTypeStateIssuer
CMM70751FOtherCAMEDICAL PROVIDER NUMBER
LAB10463FOtherCAMEDICAL
CMM70760FOtherCAMEDICAL PROVIDER NUMBER
GR0081280OtherCAMEDICAL GROUP PROVIDER N.
RHM18531FOtherCAMEDICAL PROVIDER NUMBER
HAP18531FOtherCAMEDICAL
CE0652OtherMEDICARE RAILROAD
CMM70753FOtherCAMEDICAL PROVIDER NUMBER
CMM70762FOtherCAMEDICAL PROVIDER NUMBER
BCP18531FOtherCABCEDP
CMM70759FOtherCAMEDICAL PROVIDER NUMBER
ZZR11501FOtherCAMEDICAL PROVIDER NUMBER
CMM70757FOtherCAMEDICAL PROVIDER NUMBER
CMM70758FOtherCAMEDICAL PROVIDER NUMBER
EXE70074FOtherCAMEDICAL PROVIDER NUMBER

Other names 1

  • Stanislaus County Health Services Agency Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031111000939 CA Part B Supplier - Clinic/Group Practice 0648183996 Receives reassigned benefits from 59 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Modesto, CA; Ceres, CA
O20090828000352 CA Part B Supplier - Mass Immunization (Roster Biller Only) 0648183996 Practice locations: Modesto, CA

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1524 McHenry Ave
Ste 300
Modesto, CA 95350
Phone (209) 527-0615

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Stanislaus County Health Services Agency Family & Pediatric Health CenModesto, CA, CCN 051122 Federally qualified health center Operational/Managerial Control Sep 20, 2007
Stanislaus County Health Services Agency McHenry Medical OfficeModesto, CA, CCN 051121 Federally qualified health center Operational/Managerial Control Sep 20, 2007
Stanislaus County Health Services Agency Paradise Medical OfficeModesto, CA, CCN 051117 Federally qualified health center Operational/Managerial Control Sep 20, 2007

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • County of Stanislaus

    dba Stanislaus County Health Services Agency McHenry Medical Office

    • Clinic/Center
    • Modesto, CA
    • NPI 1093910275

    Operational/Managerial Control

    CMS ownership
  • County of Stanislaus

    dba Stanislaus County Health Services Agency Paradise Medical Office

    • Clinic/Center
    • Modesto, CA
    • NPI 1396941464

    Operational/Managerial Control

    CMS ownership
  • County of Stanislaus

    dba Stanislaus County Health Services Agency Pediatrics Center

    • Clinic/Center
    • Modesto, CA
    • NPI 1891991741

    Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727913600000",
    "number": "1629094891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 SCENIC DR",
            "address_2": "MODESTO, CA SUITE B",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953506131",
            "telephone_number": "209-558-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 SCENIC DR",
            "address_2": "MODESTO, CA SUITE B",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953506131",
            "telephone_number": "209-558-7000",
            "fax_number": "209-558-8611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF STANISLAUS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "MARY ANN",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "209-558-7163"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER NUMBER",
            "identifier": "CMM70751F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "LAB10463F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER NUMBER",
            "identifier": "CMM70760F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL GROUP PROVIDER N.",
            "identifier": "GR0081280",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER NUMBER",
            "identifier": "RHM18531F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "HAP18531F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CE0652",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER NUMBER",
            "identifier": "CMM70753F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER NUMBER",
            "identifier": "CMM70762F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCEDP",
            "identifier": "BCP18531F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER NUMBER",
            "identifier": "CMM70759F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER NUMBER",
            "identifier": "ZZR11501F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER NUMBER",
            "identifier": "CMM70757F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER NUMBER",
            "identifier": "CMM70758F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER NUMBER",
            "identifier": "EXE70074F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stanislaus County Health Services Agency",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.