NPIMap

Individual provider Active NPI

Mani Mahdyoon, MD

  • Internal Medicine Physician
  • Lodi, CA
National Provider Identifier
1144232349
Registry record updated Dec 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A65782 Issued in CA
Practice address
845 S Fairmont Ave Ste 5
Lodi, CA 95240-5113
Phone
(209) 366-2360
Fax
(209) 366-2352
NPI assigned
Aug 13, 2006
Last updated
Dec 31, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 31, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A65782 CA
Internal Medicine Physician 207R00000X A65782 CA Primary

Addresses

Primary practice location

845 S Fairmont Ave Ste 5
Lodi, CA 95240-5113

Mailing address

845 S Fairmont Ave Ste 5
Lodi, CA 95240-5113
Phone (209) 366-2360

Other identifiers 1

IdentifierTypeStateIssuer
00A657820MedicaidCA

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
I20040610000615 CA Practitioner - Internal Medicine 4688655806 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

845 S Fairmont Ave
Suite 5
Lodi, CA 95240-5113
Phone (209) 366-2316

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.29 of 100Reported as individual
Quality
100
Improvement activities
40
Cost
77.63

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions53
Removal or shaving of skin growth16
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A65782CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mani Mahdyoon, M.D., a Professional Corporation Internal Medicine CurrentSince Jul 1, 2005 Accepting new patients
Sutter Gould Medical Foundation Emergency Medicine Past Accepting new patients
Ronald G Navone, M.D., a Professional Corporation Internal Medicine PastSince Jul 1, 2005 Accepting new patients
Lodi Memorial Hospital Association Inc Past Accepting new patients

Locations

845 S Fairmont Ave
Ste 5
Lodi, CA 95240
Phone (209) 366-2085

975 S Fairmont Ave
Lodi, CA 95240
Phone (209) 339-7575

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 6

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": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451520000000",
    "number": "1144232349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 S FAIRMONT AVE STE 5",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405113",
            "telephone_number": "209-366-2360",
            "fax_number": "209-366-2352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 S FAIRMONT AVE STE 5",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405113",
            "telephone_number": "209-366-2360",
            "fax_number": "209-366-2352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHDYOON",
        "first_name": "MANI",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2015-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A65782",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A65782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A657820",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lodi, CA

Sources for this page

Verify at the official NPI Registry.