DR. JONATHAN MATTHEW PETTEGREW (NPI# 1053552745) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053552745 |
| Entity Type | Individual |
| Full Name | DR. JONATHAN MATTHEW PETTEGREW |
| Credential | D.O. |
| Practice Address |
609 E Orangeburg Ave Suite 201 Modesto CA 95350-5512 |
| Practice Telephone | 2095723224 |
| Practice Fax Number | 2095724528 |
| Mailing Telephone | 2095723224 |
| Mailing Fax Number | 2095724528 |
| Enumeration Date | 2009-03-10 |
| Last Update Date | 2014-06-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
20A13395 | CA | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
609 E ORANGEBURG AVE SUITE 201 |
| City | MODESTO |
| State | CA |
| Zip Code | 95350-5512 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033111026 | Marc A Trzeciak | Orthopaedic Surgery | 609 E Orangeburg Ave, Suite 201, Modesto, CA 95350-5512 | 2005-08-10 |
| 1184266389 | Cynthia Rae Lemos | Occupational Therapist | 609 E Orangeburg Ave, Modesto, CA 95350-5512 | 2019-10-09 |
| 1154688414 | Brandy R Chapin | Specialist/Technologist, Other | 609 E Orangeburg Ave, Suite 201, Modesto, CA 95350-5512 | 2012-04-11 |
| 1528394202 | Ehsan Tabaraee | Orthopaedic Surgery | 609 E Orangeburg Ave, Suite 201, Modesto, CA 95350-5512 | 2009-10-30 |
| 1508095613 | Julie Kay Wampler | Specialist/Technologist, Other | 609 E Orangeburg Ave, Suite 201, Modesto, CA 95350-5512 | 2009-07-09 |
| 1386892529 | Pacific Medical, Inc. | Durable Medical Equipment & Medical Supplies | 609 E Orangeburg Ave, Suite 102, Modesto, CA 95350-5512 | 2008-08-29 |
| 1477746501 | Stanislaus Orthopaedics Sports Medicine Clinic | Podiatrist | 609 E Orangeburg Ave, #201, Modesto, CA 95350-5512 | 2007-08-22 |
| 1972720357 | Hailey K. Himes | Physical Therapist | 609 E Orangeburg Ave, 101, Modesto, CA 95350-5512 | 2007-04-19 |
| 1184749830 | Carolyn Levesey Pease | Physical Therapist | 609 E Orangeburg Ave, 101, Modesto, CA 95350-5512 | 2007-03-20 |
| 1669505160 | Stanislaus Orthopaedic and Sports Medicine Clinic | Specialist | 609 E Orangeburg Ave, Modesto, CA 95350-5580 | 2007-03-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164020459 | Karina Montes Rodriguez | Case Manager/Care Coordinator | Cip 1540 Florida Ave, Suite 212, Modesto, CA 95350 | 2020-10-09 |
| 1134737315 | Dr. Jeffrey A. Saladin, Dental Corporation | Dentist | 2057 Tully Road, Suite A, Modesto, CA 95350 | 2020-07-14 |
| 1588211254 | Karla Junuen Toscano | Licensed Vocational Nurse | 1235 Mchenry Ave. Suites A&b, Modesto, CA 95350 | 2019-08-19 |
| 1831694769 | Loretta Myers-weber | Nurse Practitioner | 1510 Florida Ave Ste A, Modesto, CA 95350 | 2018-03-23 |
| 1720599632 | Coral Alejandra Amador | Counselor | 1700 Mchenry Village Way, Suite 11b, Modesto, CA 95350 | 2017-10-18 |
| 1053820522 | Pannu and Henne Dental Corp. | Dentist | 3219 Mc Henry Ave, Suite E, Modesto, CA 95350 | 2017-09-27 |
| 1346779709 | Kevin Sotelo | Behavior Technician | 2630 W Rumble Road, Modesto, CA 95350 | 2017-06-08 |
| 1255869566 | Hoa Xuan Phan | Family Medicine | 1441 Florida Ave Ste 200, Modesto, CA 95350 | 2017-05-31 |
| 1356881163 | Brady S Marshall | Dentist | 201 E. Orangeburg Avenue, Suite C, Modesto, CA 95350 | 2017-02-27 |
| 1750755476 | Caremore Health Plan | Nurse Practitioner | 1234 Mchenry Avenue, Modesto, CA 95350 | 2015-11-18 |
| Find all providers in zip 95350 | ||||
| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730427782 | Milton Curtis David | Orthopaedic Surgery | 2708 Veneto Dr, Modesto, CA 95356-9337 | 2013-01-25 |
| 1992999817 | Greg Steven Takenishi | Orthopaedic Surgery | 4601 Dale Rd, Modesto, CA 95356-9718 | 2007-09-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790341618 | Casey S Revenko | Orthopaedic Surgery | 2999 Regent St Ste 225, Berkeley, CA 94705-2117 | 2019-05-15 |
| 1225504301 | Amgad Alfred | Orthopaedic Surgery | 18145 Us Highway 18 Ste D, Apple Valley, CA 92307-2210 | 2018-10-16 |
| 1386136430 | Valley River Orthopedics and Sports Medicine | Orthopaedic Surgery | Valley River Orthopedics & Sports Medicine Inc, 3329 G St Ste A, Merced, CA 95340 | 2018-06-05 |
| 1073026696 | Optimal Physician Surgical Group | Orthopaedic Surgery | 25067 Jim Bridger Rd, Hidden Hills, CA 91302-1128 | 2017-11-06 |
| 1336669456 | Beach Cities Orthopedics Surgery Center, LLC | Orthopaedic Surgery | 400 S Sepulveda Blvd Ste 110, Manhattan Beach, CA 90266-6814 | 2017-06-20 |
| 1750818860 | Health Link Medical Group Inc | Orthopaedic Surgery | 899 Northgate Dr Ste 400, San Rafael, CA 94903-3667 | 2017-05-19 |
| 1962861476 | Mehta Orthopedics | Orthopaedic Surgery | 32145 Alvarado Niles Rd Ste 209, Union City, CA 94587-2930 | 2016-02-12 |
| 1649646282 | Bay Area Surgical Specialists, Inc. A Medical Corporation | Orthopaedic Surgery | 5924 Stoneridge Dr Ste 202, Pleasanton, CA 94588-5400 | 2015-08-18 |
| 1114346111 | Sean Robinson | Orthopaedic Surgery | 7551 Timberlake Way Ste 200, Sacramento, CA 95823-5422 | 2014-04-08 |
| 1851717938 | William R Campbell Do Prof Corp | Orthopaedic Surgery | 1 Daniel Burnham Ct Ste 365c, San Francisco, CA 94109-5490 | 2014-03-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.