Thadeo J Aceves, PA-C
Individual provider Active NPI Physician Assistant · Modesto, CA
NPI 1821358375 · NPPES record last updated Jan 13, 2021
Key facts
- NPI
- 1821358375
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA22255 (CA)
- Practice address
- 1441 Florida Ave
Modesto, CA 95350-4404 - Phone
- (209) 576-3525
- Fax
- (209) 576-3544
- NPI assigned
- May 17, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120716000332 | CA | Practitioner - Physician Assistant | 5395901508 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospitalists of Modesto Medical Group | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA22255 | CA | Yes |
Addresses
Primary practice location
1441 Florida Ave
Modesto, CA 95350-4404
Mailing address
1700 McHenry Ave
Ste 65B #259
Modesto, CA 95350
Phone (209) 576-3525
Other practice location 1
1114 6th St
Modesto, CA 95354-2203
Phone (209) 576-2845
Other providers in Modesto, CA
- Corina Acevedo
- Eva Acevedo
- Jessica Acevedo
- Laura Acevedo
- Osiris Acevedo
- Nagui Achamallah
- Joydev Acharya
- Ariel Achazo
- Seth Ackuayi
- Claudia Edith Acosta Canela
All providers in Modesto, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.