PRUDENCE TICKNOR RD
NPI 1174920821
Dietitian, Registered in Modesto, CA
About Prudence Ticknor Rd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PRUDENCE TICKNOR RD (NPI 1174920821) is an individual dietitian, registered in Modesto, California, licensed in North Carolina (819773) and active in the NPI registry since November 2014. She is a graduate of Other (1997).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Prudence Ticknor Rd is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Prudence Ticknor reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Modesto, CA 95350
- Reassigned Medicare billing, California enrollment
- 11 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 95355 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 9
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
MODESTO, CA 95355
MODESTO, CA 95355
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 Prudence Ticknor's NPI number?
The NPI number for Prudence Ticknor is 1174920821. It was assigned to this individual provider in the NPPES registry on November 24, 2014.
Where is Prudence Ticknor located?
Prudence Ticknor practices at 1552 Coffee Rd Suite 200, Modesto, CA 95355. The listed phone number is (209) 248-7168.
What is Prudence Ticknor's specialty?
The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.
Is Prudence Ticknor enrolled in Medicare?
Yes. Prudence Ticknor is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Prudence Ticknor's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Prudence Ticknor reassigns Medicare benefits to Central California Bariatric Surgery A Medical Corporation (Modesto, CA). The 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 Prudence Ticknor's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Prudence Ticknor accept?
Health plans from Anthem Blue Cross and Blue Shield and Blue Cross and Blue Shield of NC list Prudence Ticknor as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Prudence Ticknor was last updated on March 21, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.
# Prudence Ticknor, RD · NPI 1174920821
Dietitian, Registered provider in Modesto, California. Individual provider, active in the CMS NPPES registry since November 24, 2014.
## Identity
- **NPI:** 1174920821 (Entity type: Individual)
- **Enumerated:** November 24, 2014
- **Primary specialty:** Dietitian, Registered · taxonomy 133V00000X
- **State license:** 819773 (North Carolina)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1552 COFFEE RD, SUITE 200, Modesto, CA 95355-3122
- **Phone:** (209) 248-7168
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Bills Medicare through:** Central California Bariatric Surgery A Medical Corporation (NPI 1124141163, Modesto, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 1997
## Record status
- **NPPES last updated:** March 21, 2017
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Source: [NPI Profile](https://npiprofile.com/npi/1174920821) · Data from the CMS NPPES public registry.