Modesto Primary Care

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

A17110 Issued in CA

Legal business name

MODESTO PRIMARY CARE

Practice address

2020 Coffee Rd Ste J2
Modesto, CA 95355-2416

Phone

(209) 572-0191

NPI assigned

Jul 13, 2006

Last updated

Aug 6, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michelle Wattle

Title

Office Manager

Phone

(209) 575-4575

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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.

• John T. Duong, M.D.

  • Internal Medicine Physician
  • Long Beach, CA
  • NPI 1356364889
  NPD (past)
• Min H. Wu, MD

  • Urgent Care Clinic/Center
  • Turlock, CA
  • NPI 1063590560
  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217980800000",
    "number": "1841215530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4398",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953524398",
            "telephone_number": "209-575-4575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 COFFEE RD STE J2",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552416",
            "telephone_number": "209-572-0191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODESTO PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2008-08-06",
        "status": "A",
        "authorized_official_last_name": "WATTLE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "209-575-4575"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A17110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0086820",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Modesto Orthopedic Group
• Modesto Orthopedic Medical Group (Modesto Orthopedic Group)
• Modesto Pain Diagnostic Treatment Center
• Modesto Pediatrics
• Modesto Physical Therapy
• Modesto Radiological Medical Group, Inc.
• Modesto Radiology Imaging, Inc.
• Modesto Residential Living Center
• Modesto Senior Living Limited Partnership (Sundial Senior Living Community)
• Modesto SNF Operations LLC (Golden Modesto Care Center)

• Primary Care Clinic/Center in Modesto, CA
• Providers in Modesto, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.