NPIMap

Individual provider Active NPI

Mussa Banisadre, MD

  • Hematology & Oncology Physician
  • Modesto, CA
National Provider Identifier
1043264690
Registry record updated Apr 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
A38740 Issued in CA
Practice address
1325 Melrose Ave
Suite a
Modesto, CA 95350-5508
Phone
(209) 524-7000
Fax
(209) 527-5601
NPI assigned
May 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X A38740 CA Primary

Addresses

Primary practice location

1325 Melrose Ave
Suite a
Modesto, CA 95350-5508

Mailing address

1325 Melrose Ave
Suite a
Modesto, CA 95350-5508
Phone (209) 524-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080122000771 CA Practitioner - Hematology 7315907524 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology
Education
Other, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stockton Hematology Oncology Medical Group IncGroup PAC ID 1456369800, 9 clinicians

Practice addresses (Care Compare)

1325 Melrose Ave
Suite a
Modesto, CA 95350-5581
Phone (209) 524-7000

2626 N California St
Suite B
Stockton, CA 95204-5500
Phone (209) 466-2626

2626 N California St B
Stockton, CA 95204-5500

Hospital & facility affiliations

  • Doctors Medical Center Hospital, Modesto, CA, CCN 050464
  • Oak Valley Hospital District Hospital, Oakdale, CA, CCN 050067
  • Adventist Health Sonora Hospital, Sonora, CA, CCN 050335
  • Emanuel Medical Center Hospital, Turlock, CA, CCN 050179

Merit-based Incentive Payment System (MIPS)

Final score
93.02 of 100Reported as group
Quality
71.01
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A38740CAMDHematology & Oncology Physician

Practice roles (4 of 5)

OrganizationSpecialtyStatusNew patients
Stockton Hematology Oncology Medical Group, Inc Hematology & Oncology CurrentSince Dec 1, 2022 Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
Mussa Banisadre MD Inc Hematology & Oncology PastSince Jul 19, 1982 Accepting new patients
Doctors Medical Center of Modesto, Inc. Past Accepting new patients

Locations

1325 Melrose Ave
Ste A
Modesto, CA 95350
Phone (209) 524-7000

2626 N California St
Ste B
Stockton, CA 95204
Phone (209) 466-2626

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir.prod.flatiron.io/fhir/

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208131200000",
    "number": "1043264690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 MELROSE AVE",
            "address_2": "SUITE A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953505508",
            "telephone_number": "209-524-7000",
            "fax_number": "209-527-5601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 MELROSE AVE",
            "address_2": "SUITE A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953505508",
            "telephone_number": "209-524-7000",
            "fax_number": "209-527-5601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANISADRE",
        "first_name": "MUSSA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2008-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CA",
            "license": "A38740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.