OrganizationActive
Providence Family Practice Medical Group
NPI 1104979582 · Family Medicine Physician · Modesto, CA
Provider details
- NPI number
- 1104979582
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Kathie Cronin, Managing Partner(209) 491-2500
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1213 Coffee Rd
Suite B
Modesto, CA 95355-4229
Phone: (209) 491-2500
Fax: (209) 491-2545
Street-level locationGet directions
Mailing address
1213 Coffee Rd
Modesto, CA 95355-4229
Registry dates
- Enumerated
- 2007-01-19
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.