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Sidney Joseph Modiste

Anesthesiology

Allopathic & Osteopathic Physicians

3315 Watt Ave, Sacramento, CA 95821-3600

PECOS Enrollment

This provider is enrolled in PECOS as SIDNEY MODISTE.

Based on the most recent information from CMS, provider Sidney Joseph Modiste is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 10:50 AM.

Profile Details

Provider ID
1275527277
Provider Type
Individual
Full Name
Modiste, Sidney Joseph
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
9/6/2005
Last Updated
12/8/2010

Contact Information

Practice Location

3315 Watt Ave, Sacramento, CA 95821-3600

(916) 481-6800

(916) 481-1881

Mailing Location

PO Box 660910, Sacramento, CA 95866-0910

(916) 481-6800

(916) 481-1881

Provider Taxonomies

Code	Description	License
Code 207L00000X Primary	Description Anesthesiology Allopathic & Osteopathic Physicians	License A46110 California

Provider Identifiers

ID	Description	Issuer
ID GR0028370	Description Medicaid	Issuer Unlisted California

Sidney Joseph Modiste

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Noud, George Eugene

Mannis, Stephen Allan

Winn, Niyati M

Maniya, Akbar Yusuf

Bahre, Bonita Marie

Hosseini, Nima

Paddock, Karen Louise

Brainin-Mattos, Josue

Brooksby, Norman Glen

Son, Kenneth Soo