NPIMap

Individual provider Active NPI

Kevin Kaye Mikaelian, M.D.

  • Orthopaedic Surgery Physician
  • Stockton, CA
National Provider Identifier
1093712200
Registry record updated Oct 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
G78209 Issued in CA
Practice address
2545 W Hammer LN
Stockton, CA 95209-2839
Phone
(209) 957-7050
NPI assigned
Jul 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X G78209 CA Primary

Addresses

Primary practice location

2545 W Hammer LN
Stockton, CA 95209-2839

Mailing address

600 Coffee Rd
Modesto, CA 95355-4201
Phone (209) 524-1211

Other identifiers 1

IdentifierTypeStateIssuer
0219850005OtherCACIGNA MEDICARE PIN

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
I20081013000268 CA Practitioner - Orthopedic Surgery 6002818176 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

2505 W Hammer LN
Stockton, CA 95209-2839
Phone (209) 957-7050

2545 W Hammer LN
Stockton, CA 95209-2839
Phone (209) 957-7050

2800 L St
Sacramento, CA 95816-5616

815 Court St
Jackson, CA 95642-2154

918 S Fairmont Ave
Lodi, CA 95240-5119
Phone (209) 366-2001

924 S Fairmont Ave
Lodi, CA 95240-5119
Phone (209) 334-2590

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement33
Knee replacement107
Lower limb (leg) arthroscopy (minimally invasive joint repair)33
Upper limb (arm) arthroscopy (minimally invasive joint repair)30

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
78209CAMDMental Health Counselor
G78209CAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation Orthopaedic Surgery CurrentSince Mar 1, 2016 Accepting new patients
San Joaquin Faculty Medical Group CurrentSince Jan 10, 2010 Accepting new patients
Stockton Orthopedic Medical Group, Inc. Orthopaedic Surgery Past Accepting new patients
Sutter North Medical Foundation Past Accepting new patients
Dameron Hospital Association Past Accepting new patients
Port City Operating Company, LLC Past Accepting new patients

Locations

500 W Hospital Rd
French Camp, CA 95231
Phone (209) 468-6000

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

Interoperability endpoints

  • Direct secure messaging: kmikaelian39169@hisp.ehr.sutterhealth.org

Organizations & group practices 6

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 8

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

NPI Registry JSON

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288224000000",
    "number": "1093712200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554201",
            "telephone_number": "209-524-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2545 W HAMMER LN",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952092839",
            "telephone_number": "209-957-7050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKAELIAN",
        "first_name": "KEVIN",
        "middle_name": "KAYE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-01",
        "last_updated": "2010-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "G78209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA MEDICARE PIN",
            "identifier": "0219850005",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.