NPIMap

Organization Active NPI

Crescent Wound Care Inc

  • Internal Medicine Physician
  • Modesto, CA
National Provider Identifier
1841920501
Registry record updated Oct 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CRESCENT WOUND CARE INC
Practice address
1310 W Granger Ave
Modesto, CA 95350-3911
Phone
(858) 936-7307
NPI assigned
Jun 15, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2024

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

Authorized official

Name
Mohamed Kadry-Hassanein, MDNPI 1164794673
Title
President
Phone
(858) 967-3070

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1310 W Granger Ave
Modesto, CA 95350-3911

Mailing address

5580 La Jolla Blvd # 622
La Jolla, CA 92037-7651
Phone (858) 936-7307

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220719000466 CA Part B Supplier - Clinic/Group Practice 3274914502 Receives reassigned benefits from 45 practitioners
Practice locations: Stockton, CA; West Sacramento, CA; Salida, CA; Modesto, CA; Lodi, CA; Hayward, CA; Sacramento, CA

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Crescent Wound Care Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 48

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

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1655251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729987200000",
    "number": "1841920501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5580 LA JOLLA BLVD # 622",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920377651",
            "telephone_number": "858-936-7307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 W GRANGER AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953503911",
            "telephone_number": "858-936-7307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT WOUND CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-15",
        "last_updated": "2024-10-27",
        "certification_date": "2024-10-27",
        "status": "A",
        "authorized_official_last_name": "KADRY-HASSANEIN",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-967-3070",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2024; 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.