Individual provider Active NPI

Theresa M NG, D.O.

  • Pediatrics Physician
  • Modesto, CA
National Provider Identifier
1730274507
Registry record updated Mar 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
11197 Issued in CA
Practice address
1510 Florida Ave
Suie F
Modesto, CA 95350-4437
Phone
(209) 549-7090
Fax
(209) 549-7099
NPI assigned
Oct 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X R-7835 IA
Pediatrics Physician 208000000X 11197 CA Primary

Addresses

Primary practice location

1510 Florida Ave
Suie F
Modesto, CA 95350-4437

Mailing address

737 W Childs Ave
Merced, CA 95341-6805
Phone (209) 383-1848

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100719000729 CA Practitioner - Pediatric Medicine 2961534433 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R-7835IAMDPediatrics Physician
11197CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc Pediatrics Current Accepting new patients
Golden Valley Health Center Current Accepting new patients
Golden Valley Health Center Current Accepting new patients
Permanente Medical Group, Inc CurrentSince Jun 10, 2024 Accepting new patients
Golden Valley Health Center Current Accepting new patients
Golden Valley Health Center Current Accepting new patients
Golden Valley Health Center Current Accepting new patients
Golden Valley Health Centers Current Accepting new patients
Golden Valley Health Center Current Accepting new patients
Golden Valley Health Center Current Accepting new patients
Golden Valley Health Center Current Accepting new patients
Golden Valley Health Center Current Accepting new patients
Golden Valley Health Center Current Accepting new patients
Golden Valley Health Center Current Accepting new patients
Golden Valley Health Centers CurrentSince Jul 12, 2010 Accepting new patients
Golden Valley Health Center CurrentSince Jul 12, 2010 Accepting new patients
Permanente Medical Group Inc Pediatrics CurrentSince Jun 10, 2024 Accepting new patients

Locations

750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131

4753 W Shaw Ave
Ste 101
Fresno, CA 93722
Phone (559) 277-8738

900 N Douty St
Hanford, CA 93230
Phone (559) 587-9014

737 W Childs Ave
Merced, CA 95341
Phone (209) 383-1848

4125 Bangs Ave
Modesto, CA 95356
Phone (209) 557-1000

1510 Florida Ave
Ste F
Modesto, CA 95350
Phone (209) 549-7090

2101 Tenaya Dr
Modesto, CA 95354
Phone (209) 576-6766

1800 Harrison St
Fl 7
Oakland, CA 94612

101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

930 W Main St
Ripon, CA 95366
Phone (209) 599-4221

501 J St
Sacramento, CA 95814
Phone (916) 497-3000

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

320 N Crawford St
Willows, CA 95988
Phone (530) 934-2834

Organizations & group practices 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584316800000",
    "number": "1730274507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 W CHILDS AVE",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953416805",
            "telephone_number": "209-383-1848",
            "fax_number": "209-383-1296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 FLORIDA AVE",
            "address_2": "SUIE F",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504437",
            "telephone_number": "209-549-7090",
            "fax_number": "209-549-7099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NG",
        "first_name": "THERESA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IA",
            "license": "R-7835",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "11197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.