Frank Edward Modic, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

G56491 Issued in CA

Practice address

121 Sotoyome St
Santa Rosa, CA 95405-4823

Phone

(707) 546-4062

Fax

(707) 525-4097

NPI assigned

Oct 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Diagnostic Radiology

Education

Columbia University College of Physicians and Surgeons, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Radia California Radiology Medical Group IncGroup PAC ID 8921465998, 134 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Santa Rosa Memorial Hospital Hospital, Santa Rosa, CA, CCN 050174
• Petaluma Valley Hospital Hospital, Petaluma, CA, CCN 050136
• Healdsburg Hospital Hospital, Healdsburg, CA, CCN 051321

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Radia California Radiology Medical Group Inc

  • Diagnostic Radiology Physician
  • Santa Rosa, CA
  • NPI 1740982032
  Medicare reassignment Care Compare group NPD
• Redwood Radiology Group Inc

  • Diagnostic Radiology Physician
  • Santa Rosa, CA
  • NPI 1326461708
  Medicare reassignment NPD Authorized official
• Annadel Medical Group, Inc

  • Pediatrics Physician
  • Santa Rosa, CA
  • NPI 1114177425
  NPD (past)
• Norcal Healthconnect LLC

  • General Acute Care Hospital
  • Petaluma, CA
  • NPI 1235162645
  NPD (past)
• Redwood Regional Medical Group Inc

  • Hematology & Oncology Physician
  • Santa Rosa, CA
  • NPI 1275556607

  Diagnostic Radiology

  NPD (past)
• Redwood Regional Medical Group, Inc.

  • Clinical Medical Laboratory
  • Santa Rosa, CA
  • NPI 1588743264
  NPD (past)
• Radia Inc P S

  • Diagnostic Radiology Physician
  • Lynnwood, WA
  • NPI 1932196607
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Norcal Healthconnect LLC

  • General Acute Care Hospital
  • Petaluma, CA
  • NPI 1235162645
  Care Compare affiliation
• Norcal Healthconnect LLC

  • Multi-Specialty Clinic/Center
  • Healdsburg, CA
  • NPI 1720695547

  Hospital

  Care Compare affiliation
• Norcal Healthconnect LLC

  • Critical Access Hospital
  • Healdsburg, CA
  • NPI 1861009672
  Care Compare affiliation
• St. Joseph Health Northern California, LLC

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1134152549
  Care Compare affiliation

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401321600000",
    "number": "1871683326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5651",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928635651",
            "telephone_number": "714-571-5000",
            "fax_number": "714-571-5055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 SOTOYOME ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054823",
            "telephone_number": "707-546-4062",
            "fax_number": "707-525-4097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODIC",
        "first_name": "FRANK",
        "middle_name": "EDWARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2014-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "CA",
            "license": "G56491",
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "CA",
            "license": "G56491",
            "primary": false
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "CA",
            "license": "G56491",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G56491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G564910",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Derek Michael Miyasaki, PHARMD
• Heidi Mize
• Deborah J Mizell, LCSW
• Mobility Masters Northern California Inc.
• Modern Sight Optometric Corporation
• Cindy Mogannam, MPH, RD, CSP
• Jiries Peter Mogannam, D.D.S., M.D.
• Karla Mogollan
• Almira Mogul
• Sophia Moh, OD

• Diagnostic Radiology Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.