NPIMap

Organization Active NPI

Central Valley Pain Management and Wellness Clinic

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Modesto, CA
National Provider Identifier
1871657403
Registry record updated Nov 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X
License
00A519490 Issued in CA
Legal business name
CENTRAL VALLEY PAIN MANAGEMENT AND WELLNESS CLINIC
Practice address
1300 Mable Avenue
Suite 2
Modesto, CA 95355-1120
Phone
(209) 571-1992
Fax
(209) 571-1994
NPI assigned
Dec 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2012

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

Authorized official

Name
Patrick Neal Rhoades, MDNPI 1972568400
Title
President
Phone
(209) 571-1992

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Neuromusculoskeletal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 204C00000X 00A519490 CA Primary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X 00A519490 CA
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X 00A519490 CA

Addresses

Primary practice location

1300 Mable Avenue
Suite 2
Modesto, CA 95355-1120

Mailing address

1300 Mable Avenue
Suite 2
Modesto, CA 95355-1120
Phone (209) 571-1992

Other identifiers 1

IdentifierTypeStateIssuer
00A519490MedicaidCA

Other names 1

  • Central Valley Pain Management Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040128001017 CA Part B Supplier - Clinic/Group Practice 8921901893 Receives reassigned benefits from 4 practitioners
Practice locations: Modesto, CA

National Provider Directory

National Provider Directory
Tax ID family
Central Valley Pain4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353888000000",
    "number": "1871657403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 MABLE AVENUE",
            "address_2": "SUITE 2",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551120",
            "telephone_number": "209-571-1992",
            "fax_number": "209-571-1994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 MABLE AVENUE",
            "address_2": "SUITE 2",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551120",
            "telephone_number": "209-571-1992",
            "fax_number": "209-571-1994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL VALLEY PAIN MANAGEMENT AND WELLNESS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2012-11-26",
        "status": "A",
        "authorized_official_last_name": "RHOADES",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "NEAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-571-1992",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "CA",
            "license": "00A519490",
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "CA",
            "license": "00A519490",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "CA",
            "license": "00A519490",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A519490",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Valley Pain Management",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Nov 26, 2012; 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.