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PROVIDENT PRIMARY CARE INC
NPI 1154785517
Clinic/Center - Primary Care in Merced, CA

Active since April 11, 2016CLIA Certified · 3 labs
3349 G ST STE C, MERCED, CA 95340(209) 580-4638(209) 580-4163 Get Directions Write a Review

NPPES record last updated: October 12, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Provident Primary Care Inc NPPES

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

PROVIDENT PRIMARY CARE INC (NPI 1154785517) is a healthcare organization registered as a primary care in Merced, California and active in the NPI registry since April 2016. The organization holds 3 active CLIA laboratory certificates, maintains 2 additional practice locations, and lists Jerry Tiu, Ceo, as its authorized official.

NPPES Registry Identity

NPI1154785517
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NamePROVIDENT PRIMARY CARE INC
Location Address3349 G ST STE CMerced, CA 95340-0978
Mailing Address3349 G St Ste CMerced, CA 95340-0978 · (209) 384-4400
Phone(209) 580-4638
Fax(209) 580-4163
Organization SubpartNo
Authorized OfficialJerry TiuCeo · (209) 384-4400
Enumeration DateApril 11, 2016
Last NPPES UpdateOctober 12, 2021
NPPES CertifiedOctober 12, 2021
✔ NPI 1154785517 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
Also ListedInternal Medicine · Pulmonary DiseaseTaxonomy 207RP1001X
Also ListedPodiatristTaxonomy 213E00000X
Also ListedNurse Practitioner · Primary CareTaxonomy 363LP2300X
3349 G ST STE C, Merced, CA 95340
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Secondary Practice Locations 2

Location 1450 E Yosemite Ave Ste AMerced, CA 95340-8429 · Phone (209) 725-1112 · Fax (209) 580-4863
Location 2410 E Yosemite Ave Ste AMerced, CA 95340-8220 · Phone (209) 384-9108 · Fax (209) 384-0580

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D1068686

Provident Primary Care Inc · Merced, CA
Active · expires May 17, 2027
CLIA Number05D1068686
Laboratory TypePhysician Office
Certificate Effective DateMay 18, 2025
Certificate Expiration DateMay 17, 2027
Laboratory DirectorMaciej G. Ossowski, MD
Laboratory Phone(209) 725-1112
Laboratory LocationProvident Primary Care Inc450 E Yosemite Avenue, Suite A, Merced, CA 95340
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D0690594

Provident Primary Care Inc · Merced, CA
Active · expires Apr 14, 2027
CLIA Number05D0690594
Laboratory TypePhysician Office
Certificate Effective DateApril 15, 2025
Certificate Expiration DateApril 14, 2027
Laboratory DirectorMaciej G. Ossowski
Laboratory Phone(209) 384-9108
Laboratory LocationProvident Primary Care Inc410 E Yosemite Ave Ste A, Merced, CA 95340
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2126191

Provident Primary Care Inc · Merced, CA
Active · expires Feb 20, 2027
CLIA Number05D2126191
Laboratory TypePhysician Office
Certificate Effective DateFebruary 21, 2025
Certificate Expiration DateFebruary 20, 2027
Laboratory DirectorMaciej G. Ossowski
Laboratory Phone(209) 580-4638
Laboratory LocationProvident Primary Care Inc3349 G St Ste C, Merced, CA 95340
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

JOSE LUIS LUNA
Nurse Practitioner (Family)
3349 G ST STE C
MERCED, CA 95340
Merced County (209) 580-4638
ERICA MCAFEE FNP
Nurse Practitioner (Family)
3349 G ST STE C
MERCED, CA 95340
Merced County (209) 580-4638
MA ANA LEON ARBO FNP
Nurse Practitioner
3349 G ST STE C
MERCED, CA 95340
Merced County (209) 580-4638

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 Provident Primary Care Inc's NPI number?

The NPI number for Provident Primary Care Inc is 1154785517. It was assigned to this organization in the NPPES registry on April 11, 2016.

Where is Provident Primary Care Inc located?

Provident Primary Care Inc is located at 3349 G St Ste C, Merced, CA 95340. The listed phone number is (209) 580-4638.

What is Provident Primary Care Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Provident Primary Care Inc hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Provident Primary Care Inc was last updated on October 12, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.