NPIMap

Individual provider Active NPI

Lakshma R Tiyyagura, MD

  • Gastroenterology Physician
  • Stockton, CA
National Provider Identifier
1164527883
Registry record updated May 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
A56285 Issued in CA
Practice address
420 W Acacia St
# 18
Stockton, CA 95203-2441
Phone
(209) 466-4685
Fax
(209) 466-4695
NPI assigned
Sep 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 11, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X A56285 CA Primary

Addresses

Primary practice location

420 W Acacia St
# 18
Stockton, CA 95203-2441

Mailing address

PO Box 7939
Stockton, CA 95267-0939
Phone (209) 466-4685

Other identifiers 2

IdentifierTypeStateIssuer
00A562851MedicaidCA
00A562850MedicaidCA

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
I20040116000974 CA Practitioner - Gastroenterology 8729989207 Practice locations: Stockton, CA

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1805 N California St
Suite 309
Stockton, CA 95204-6032
Phone (209) 466-4685

420 W Acacia St
Suite 18
Stockton, CA 95203-2441

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.17 of 100Reported as individual
Quality
95
Improvement activities
40
Cost
75.06

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy416
Upper gastrointestinal (GI) endoscopy for acid reflux297

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dameron Hospital Association Past Accepting new patients
Port City Operating Company, LLC Past Accepting new patients
Fresno Community Hospital and Medical Center Past Accepting new patients
St. Joseph'S Hospital, Yonkers Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: lakshmatiyyagura@ltmd.allscriptsdirect.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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242000000000",
    "number": "1164527883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7939",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952670939",
            "telephone_number": "209-466-4685",
            "fax_number": "204-466-4695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W ACACIA ST",
            "address_2": "# 18",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952032441",
            "telephone_number": "209-466-4685",
            "fax_number": "209-466-4695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIYYAGURA",
        "first_name": "LAKSHMA",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2009-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A56285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A562851",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A562850",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.