Individual provider Active NPI

Dimitri Sirakoff, DO

  • Family Medicine Physician
  • Santa Ana, CA
National Provider Identifier
1164467056
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A5552 Issued in CA
Practice address
1206 E 17TH St
Ste 204
Santa Ana, CA 92701-2641
Phone
(714) 835-3500
Fax
(714) 835-4619
NPI assigned
Jun 17, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A5552 CA Primary

Addresses

Primary practice location

1206 E 17TH St
Ste 204
Santa Ana, CA 92701-2641

Mailing address

1206 E 17TH St
Ste 204
Santa Ana, CA 92701-2641
Phone (714) 835-3500

Other identifiers 2

IdentifierTypeStateIssuer
0SD0899486OtherCACLIA ID
00AX55521MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070503000419 CA Practitioner - Family PracticePractitioner - General PracticePractitioner - Diagnostic RadiologyPractitioner - Geriatric MedicinePractitioner - Preventive Medicine 5496702201 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A5552CAMDFamily Medicine Physician
5552CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Serve the People, Inc Family Medicine CurrentSince Aug 28, 2019 Accepting new patients
Total Rehab Inc PastSince Apr 12, 2004 Accepting new patients

Locations

1206 E 17th St
Ste 101
Santa Ana, CA 92701
Phone (714) 352-2911

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Serve the People Community Health CenterSanta Ana, CA, CCN 751063 Federally qualified health center Corporate Director Jan 1, 2008

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1164467056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1206 E 17TH ST",
            "address_2": "STE 204",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927012641",
            "telephone_number": "714-835-3500",
            "fax_number": "714-835-4619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 E 17TH ST",
            "address_2": "STE 204",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927012641",
            "telephone_number": "714-835-3500",
            "fax_number": "714-835-4619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIRAKOFF",
        "first_name": "DIMITRI",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-17",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A5552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA ID",
            "identifier": "0SD0899486",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX55521",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

Verify at the official NPI Registry.