1. Home
  2. Directory
  3. California
  4. Modesto
  5. Family Medicine
  6. NPI Profile

PROVIDENCE FAMILY PRACTICE MEDICAL GROUP
NPI 1104979582
Family Medicine in Modesto, CA

Active since January 19, 2007
1213 COFFEE RD, SUITE B, MODESTO, CA 95355(209) 491-2500(209) 491-2545 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Providence Family Practice Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE FAMILY PRACTICE MEDICAL GROUP (NPI 1104979582) is a healthcare organization registered as a family medicine in Modesto, California and active in the NPI registry since January 2007. The organization lists Kathie Lee Cronin, Managing Partner, as its authorized official.

NPPES Registry Identity

NPI1104979582
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NamePROVIDENCE FAMILY PRACTICE MEDICAL GROUP
Location Address1213 COFFEE RD, SUITE BModesto, CA 95355-4229
Mailing Address1213 Coffee Rd, Suite BModesto, CA 95355-4229 · (209) 491-2500 · Fax (209) 491-2545
Phone(209) 491-2500
Fax(209) 491-2545
Organization SubpartNo
Authorized OfficialKathie Lee CroninManaging Partner · (209) 491-2500
Enumeration DateJanuary 19, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1104979582 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1213 COFFEE RD, Modesto, CA 95355
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 18

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

COREY ROBERT ACREE DDS
Dentist
1213 COFFEE RD, SUITE B
MODESTO, CA 95355
Stanislaus County (209) 529-0674
DARRELL ROBERT HANSEN M.D.
Family Medicine
1213 COFFEE RD, STE A
MODESTO, CA 95355
Stanislaus County (209) 549-9900
MRS. SYLVIA DIANE VICTOR LMFT
Marriage & Family Therapist
1213 COFFEE RD, SUITE P
MODESTO, CA 95355
Stanislaus County (209) 527-9043
KELLY GAINES FNP
Family Medicine
1213 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 491-2500
GRACE Y KWON-HONG
Family Medicine
1213 COFFEE RD, SUITE A
MODESTO, CA 95355
Stanislaus County (209) 549-9900
CAROLINE HOWARD
Counselor
1213 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 495-6773
MRS. BETTY KILPATRICK HANSEN M.S,
Marriage & Family Therapist
1213 COFFEE RD, SUITE P
MODESTO, CA 95355
Stanislaus County (209) 527-8943
JAMES M CARLSON MD
Family Medicine
1213 COFFEE RD, SUITE A
MODESTO, CA 95355
Stanislaus County (209) 499-9900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Family Practice Medical Group's NPI number?

The NPI number for Providence Family Practice Medical Group is 1104979582. It was assigned to this organization in the NPPES registry on January 19, 2007.

Where is Providence Family Practice Medical Group located?

Providence Family Practice Medical Group is located at 1213 Coffee Rd Suite B, Modesto, CA 95355. The listed phone number is (209) 491-2500.

What is Providence Family Practice Medical Group's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Providence Family Practice Medical Group was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.