NPIMap

Organization Active NPI

McHenry Medical Group, Inc.

  • Urology Physician
  • Manteca, CA
National Provider Identifier
1912183153
Registry record updated Jan 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
MCHENRY MEDICAL GROUP, INC.
Practice address
200 Cottage Ave
Sute 101
Manteca, CA 95336-4935
Phone
(209) 239-6005
NPI assigned
Jan 17, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2008

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

Authorized official

Name
Harris Michael Goodman, M.D.NPI 1215925771
Title
Chair
Phone
(209) 577-3388

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X Primary
Pediatric Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2088P0231X

Addresses

Primary practice location

200 Cottage Ave
Sute 101
Manteca, CA 95336-4935

Mailing address

1541 Florida Ave
Suite 200
Modesto, CA 95350-4429
Phone (209) 577-3388

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ48224ZOtherCAMEDICARE #

National Provider Directory

National Provider Directory
Tax ID family
McHenry Medical Group Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1200528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200528000000",
    "number": "1912183153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 FLORIDA AVE",
            "address_2": "SUITE 200",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504429",
            "telephone_number": "209-577-3388",
            "fax_number": "209-342-3743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 COTTAGE AVE",
            "address_2": "SUTE 101",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953364935",
            "telephone_number": "209-239-6005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCHENRY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-17",
        "last_updated": "2008-01-17",
        "status": "A",
        "authorized_official_last_name": "GOODMAN",
        "authorized_official_first_name": "HARRIS",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "CHAIR",
        "authorized_official_telephone_number": "209-577-3388",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology, Pediatric Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE #",
            "identifier": "ZZZ48224Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manteca, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 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.