CMS-1500 Box 24J / 33a • NPI
1396020947
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
207RG0100X (CMS 10)
Board-Certified Gastroenterologist (Digestive Tract & Liver Specialist)
Box 32 Service Location & ZIP+4
4206 TECHNOLOGY DR STE 2, MODESTO, CA, 95356-8769
✓ 9-Digit EDI 837 ZIP+4 (95356-8769)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1396020947 (ADVANCED SLEEP AND GASTROENTEROLOGY LABORATORIES,INC.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1396020947 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | ADVANCED SLEEP AND GASTROENTEROLOGY LABORATORIES,INC. |
| Plain-English Specialty | Board-Certified Gastroenterologist (Digestive Tract & Liver Specialist) NUCC Code: 207RG0100X (Internal Medicine, Gastroenterology) |
| Certifying / Licensing Body | American Board of Internal Medicine — Gastroenterology |
| Practice Location Address | 4206 TECHNOLOGY DR STE 2, MODESTO, CA, 95356-8769 |
| Practice Telephone / Fax | Tel: (209) 492-0735 | Fax: (209) 579-2354 |
| Administrative Mailing Address | 262 BURGENLAND AVE, TURLOCK, CA, 95382-0343 |
| Enumeration & Last Sync | Enumerated: 2011-10-14 | CMS Record Updated: 2011-10-14 |
| Authorized Official | JONATHAN DAVIDSON (CEO) |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (207RG0100X)
What Does Taxonomy Code 207RG0100X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207RG0100X translates to:
"Board-Certified Gastroenterologist (Digestive Tract & Liver Specialist)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (ADVANCED SLEEP AND GASTROENTEROLOGY LABORATORIES,INC.)
Typical CPT / Diagnostic Procedures:- Screening & Diagnostic Colonoscopy with Polypectomy (CPT 45378–45385)
- Esophagogastroduodenoscopy / Upper GI Endoscopy (EGD — CPT 43239)
- Hepatic Elastography (FibroScan) & Fractionated Bilirubin/LFT Workup
- Internal Hemorrhoid Banding & Anorectal Diagnostic Evaluation
- Proton Pump Inhibitors (Omeprazole, Pantoprazole, Esomeprazole)
- H. pylori Quadruple & Triple Eradication Regimens
- Mesalamine & Biologic Immunomodulators (Inflammatory Bowel Disease)
- Osmotic Laxatives, Rifaximin & Ursodeoxycholic Acid
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
207RS0012X — Internal Medicine, Sleep MedicinePlain English: Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician) | State: N/A | License: Verified | Primary: Secondary |
207RG0100X — Internal Medicine, GastroenterologyPlain English: Board-Certified Gastroenterologist (Digestive Tract & Liver Specialist) | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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