NPIMap

Individual provider Active NPI

Taymour Edward Malak, M.D.

  • Family Medicine Physician
  • Stockton, CA
National Provider Identifier
1104931260
Registry record updated Feb 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A400760 Issued in CA
Practice address
2800 N California St Ste 11
2800 N. California Street Suite 11
Stockton, CA 95204-3758
Phone
(209) 465-5891
Fax
(209) 465-0008
NPI assigned
Aug 20, 2006
Last updated
Feb 17, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A400760 CA Primary
General Practice Physician 208D00000X A400760 CA

Addresses

Primary practice location

2800 N California St Ste 11
2800 N. California Street Suite 11
Stockton, CA 95204-3758

Mailing address

2800 N California St Ste 11
2800 N. California Street Suite 11
Stockton, CA 95204-3758
Phone (209) 465-5891

Other identifiers 3

IdentifierTypeStateIssuer
00A4007607MedicaidCA
680045304OtherCATAX IDENTIFICATION NUMBER
A40076OtherCASTATE LICENSE NUMBER

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
I20040816001508 CA Practitioner - Family Practice 3971576430 Reassigns benefits to 1 organization
Practice locations: Stockton, CA

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pacific Urgent Care IncGroup PAC ID 2668445115, 2 clinicians

Practice addresses (Care Compare)

1782 W Hammer Lane
Stockton, CA 95207-2922
Phone (209) 475-9500

2800 N California St
Suite 11
Stockton, CA 95204-3758
Phone (209) 465-5891

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
38.9 of 100Reported as individual
Quality
20
Improvement activities
0
Cost
73.37

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A400760CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Urgent Care Inc CurrentSince May 1, 2008 Accepting new patients
St. Joseph's Hospital, Yonkers Past Accepting new patients
Hill Physicians Medical Group - PPO Program Past Accepting new patients
Norcal Urgent Care, Inc PastSince Apr 30, 2003 Accepting new patients

Locations

1782 W Hammer Ln
Stockton, CA 95209
Phone (209) 465-5891

4719 Quail Lakes Dr
Ste G
Stockton, CA 95207
Phone (202) 306-4100

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: tmalak14005@hpmg.direct-ci.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329436800000",
    "number": "1104931260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 N CALIFORNIA ST STE 11",
            "address_2": "2800 N. CALIFORNIA STREET SUITE 11",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952043758",
            "telephone_number": "209-465-5891",
            "fax_number": "209-465-0008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 N CALIFORNIA ST STE 11",
            "address_2": "2800 N. CALIFORNIA STREET SUITE 11",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952043758",
            "telephone_number": "209-465-5891",
            "fax_number": "209-465-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALAK",
        "first_name": "TAYMOUR",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2012-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A400760",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A400760",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A4007607",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION NUMBER",
            "identifier": "680045304",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "A40076",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.