PROVIDENT PRIMARY CARE INC
NPI 1154785517
Clinic/Center - Primary Care in Merced, CA
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
Specialties & Licenses 4
Secondary Practice Locations 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Provident Primary Care Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
15Medicare enrollment records show 15 clinicians reassign Medicare billing to Provident Primary Care Inc, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 12 within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 6
Clinicians, nearest first (15)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, CACertificate of Waiver 05D0690594
Provident Primary Care Inc · Merced, CACertificate of Waiver 05D2126191
Provident Primary Care Inc · Merced, CAFrequently 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.
Is Provident Primary Care Inc enrolled in Medicare?
Yes. Provident Primary Care Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Provident Primary Care Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 15 clinicians in 6 Medicare specialties reassign their Medicare billing to Provident Primary Care Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (6), Internal Medicine (3) and Podiatry (3). Of these, 2 practice at this address and 12 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 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.
# Provident Primary Care Inc · NPI 1154785517
Primary Care organization in Merced, California. Organization record, active in the CMS NPPES registry since April 11, 2016.
## Identity
- **NPI:** 1154785517 (Entity type: Organization)
- **Enumerated:** April 11, 2016
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Jerry Tiu, CEO
## Practice location
- **Address:** 3349 G ST STE C, Merced, CA 95340-0978
- **Phone:** (209) 580-4638 · **Fax:** (209) 580-4163
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 15 clinicians in 6 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (6), Internal Medicine (3), Podiatry (3); 2 practice at this address and 12 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 12, 2021
- **CLIA laboratory certificates:** 3 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1154785517) · Data from the CMS NPPES public registry.