Escalon Physical Medicine, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ESCALON PHYSICAL MEDICINE, INC

Practice address

1933 Coffee Rd
Modesto, CA 95355-2704

Phone

(209) 838-3434

Fax

(209) 838-7753

NPI assigned

Apr 7, 2014

Organization subpart

No

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

Authorized official

Name

Dr. John Bystrom, MDNPI 1891850525

Title

Owner

Phone

(209) 838-3434

Specialties & licenses 4

Addresses

Other names 1

• Modesto Physical Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Locations

Practitioners 7

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

• John Matthew Bystrom, DC

  • Chiropractor
  • Modesto, CA
  • NPI 1891850525
  Medicare reassignment Care Compare group NPD Authorized official
• Jeannette Sandoval

  • Family Medicine Physician
  • Castro Valley, CA
  • NPI 1376182402
  Medicare reassignment Care Compare group NPD
• Jose L Bazan, FNP-C

  • Family Nurse Practitioner
  • Modesto, CA
  • NPI 1437784469
  Medicare reassignment NPD
• Michael Ratliff, MSN RN FNP-C

  • Family Nurse Practitioner
  • Patterson, CA
  • NPI 1457008211
  Medicare reassignment NPD
• Michael Scott Clark, DC

  • Chiropractor
  • Lehi, UT
  • NPI 1710059035

  CA

  Medicare reassignment NPD
• Manpreet Kaur Sheabat, PA

  • Physician Assistant
  • Modesto, CA
  • NPI 1033502505
  Medicare reassignment
• William S. Clark, DO

  • Emergency Medicine Physician
  • Escalon, CA
  • NPI 1770690430

  General Practice

  NPD (past)

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

{
    "created_epoch": "1396828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673395200000",
    "number": "1821417866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1933 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552704",
            "telephone_number": "209-838-3434",
            "fax_number": "209-838-7753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1933 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552704",
            "telephone_number": "209-838-3434",
            "fax_number": "209-838-7753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESCALON PHYSICAL MEDICINE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-07",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A",
        "authorized_official_last_name": "BYSTROM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-838-3434",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A74921",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modesto Physical Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alyssa Ernst
• Lee James Ervin, PH.D.
• Lezzette Carmen Ervin
• Jessica Escalante
• Nicolas Escalera
• Elizabeth Escobar Ortega
• Ashley Niccolle Escobar-Vargas
• Gregory Issac Escobar
• Lucilita P Escobar
• Nicole Alejandra Escobar

• Family Medicine Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; 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.