NPIMap

Individual provider Active NPI

Gervacio D Diaz III, M.D.

  • Internal Medicine Physician
  • Modesto, CA
National Provider Identifier
1700835451
Registry record updated Mar 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A69801 Issued in CA
Practice address
2013 Coffee Rd
Modesto, CA 95355-2405
Phone
(209) 529-8506
Fax
(209) 529-8524
NPI assigned
May 9, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A69801 CA Primary

Addresses

Primary practice location

2013 Coffee Rd
Modesto, CA 95355-2405

Mailing address

2013 Coffee Rd
Modesto, CA 95355-2405
Phone (209) 529-8506

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gdiaz@GDiaz.ssdirect.aprima.com Direct

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
I20061214000411 CA Practitioner - Internal Medicine 7911906219 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1988
Medicare assignment
May accept Medicare assignment
Group practices
Sutter Valley Medical Foundation 2,473 clinicians

Practice addresses (Care Compare)

1011 Sylvan Ave
Suite C
Modesto, CA 95350-1693
Phone (209) 550-4780

2013 Coffee Rd
Modesto, CA 95355-2405
Phone (209) 529-8506

600 Coffee Rd
Modesto, CA 95355-4201
Phone (209) 524-1211

Hospital & facility affiliations

  • Careone Home Health and Hospice, Inc Home health agency, Salida, CA, CCN 059401
  • Sutter Care at Home Home health agency, Salida, CA, CCN 057695
  • Lifeguard Home Health Home health agency, Pleasanton, CA, CCN 059055
  • Memorial Medical Center Hospital, Modesto, CA, CCN 050557
  • Doctors Medical Center Hospital, Modesto, CA, CCN 050464

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A69801CAMDInternal Medicine Physician

Practice roles (7 of 8)

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation Internal Medicine CurrentSince Aug 1, 2025 Accepting new patients
Sutter Valley Medical Foundation CurrentSince Aug 1, 2025 Accepting new patients
Gervacio D Diaz III MD Inc Internal Medicine CurrentSince Sep 15, 2006 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Walter Wai-Tak Chien MD, a Professional Corporation Past Accepting new patients
Doctors Medical Center of Modesto, Inc. Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients

Locations

2720 Low Ct
Fairfield, CA 94534
Phone (707) 428-2731

815 Court St
Ste 7
Jackson, CA 95642
Phone (209) 257-5900

2013 Coffee Rd
Modesto, CA 95355
Phone (209) 529-0758

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

250 W Main St
Woodland, CA 95695
Phone (916) 668-6100

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: gdiaz@gdiaz.ssdirect.aprima.com
  • Direct secure messaging: gdiaz13042@hisp.ehr.sutterhealth.org

Organizations & group practices 29

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.

View all 29

Hospital & facility affiliations 5

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": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678665600000",
    "number": "1700835451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2013 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552405",
            "telephone_number": "209-529-8506",
            "fax_number": "209-529-8524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2013 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552405",
            "telephone_number": "209-529-8506",
            "fax_number": "209-529-8524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "GERVACIO",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A69801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gdiaz@GDiaz.ssdirect.aprima.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2013 Coffee Rd",
            "city": "Modesto",
            "state": "CA",
            "country_code": "US",
            "postal_code": "953552405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.