NPIMap

Individual provider Active NPI

Kevin Charles Booth, M.D.

  • Orthopaedic Surgery of the Spine Physician
  • Sonora, CA
National Provider Identifier
1104822832
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
G77956 Issued in CA
Practice address
900 Greenley Rd Ste 914
Sonora, CA 95370-5287
Phone
(095) 365-7782
Fax
(209) 536-5779
NPI assigned
Jun 27, 2005
Last updated
Oct 9, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery of the Spine Physician 207XS0117X G77956 CA Primary

Addresses

Primary practice location

900 Greenley Rd Ste 914
Sonora, CA 95370-5287

Mailing address

900 Greenley Rd Ste 914
Sonora, CA 95370-5287
Phone (209) 536-5778

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
I20100225000180 CA Practitioner - Orthopedic Surgery 9739242215 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Loma Linda University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sonora Community HospitalGroup PAC ID 4284538505, 134 clinicians

Practice addresses (Care Compare)

200 W Roseburg Ave
Suite B1
Modesto, CA 95350-5200
Phone (209) 536-5776

900 Greenley Rd
Suite 914
Sonora, CA 95370-5287
Phone (209) 536-5778

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.77 of 100Reported as apm
Quality
81.54
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
84.78 of 100Reported as group
Quality
81.74
Promoting interoperability
97
Improvement activities
40
Cost
67.27

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion183
Laminectomy or laminotomy (partial removal of spine bones)63

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G77956CAMDOrthopaedic Surgery of the Spine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Physicians Network Current Accepting new patients
Adventist Health Physicians Network CurrentSince Jul 1, 2019 Accepting new patients
Sonora Community Hospital CurrentSince Aug 1, 2020 Accepting new patients
Adventist Health Physicians Network CurrentSince Jul 1, 2019 Accepting new patients
Sonora Community Hospital CurrentSince Aug 1, 2020 Accepting new patients
Sonora Community Hospital Current Accepting new patients
Stanford Health Care Tri-Valley Past Accepting new patients
Washington Township Hospital District Past Accepting new patients
Tri-Valley Orthopedic and Sports Medical Group Inc Orthopaedic Surgery of the Spine Past Accepting new patients
Sonora Community Hospital Past Accepting new patients
Eden Medical Center/San Leandro Hospital Campus Past Accepting new patients
Tri-Valley Orthopedic and Sports Medical Group Inc Orthopaedic Surgery of the Spine Past Accepting new patients

Locations

1524 W Lacey Blvd
Ste 101
Hanford, CA 93230
Phone (559) 583-4695

200 W Roseburg Ave
Ste B1
Modesto, CA 95350
Phone (209) 491-2500

5725 W Las Positas Blvd
Ste 200
Pleasanton, CA 94588
Phone (925) 469-3120

680 Guzzi Ln
Ste 106
Sonora, CA 95370
Phone (209) 532-2792

680 Guzzi Ln
Ste 201
Sonora, CA 95370
Phone (209) 536-1785

900 Greenley Rd
Ste 914
Sonora, CA 95370
Phone (209) 532-6128

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 12

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

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": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1104822832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 GREENLEY RD STE 914",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705287",
            "telephone_number": "209-536-5778",
            "fax_number": "925-924-1769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 GREENLEY RD STE 914",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705287",
            "telephone_number": "095-365-7782",
            "fax_number": "209-536-5779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "KEVIN",
        "middle_name": "CHARLES",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "CA",
            "license": "G77956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sonora, CA

Sources for this page

Verify at the official NPI Registry.