Active NPI
Roy Anunciacion, M.D.
- Pediatrics Physician
- Lodi, CA
National Provider Identifier
1205839735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A74550
- Practice address
- 1920 Tienda Dr
Ste 102
Lodi, CA 95242-3930 - Phone
- (209) 368-8310
- NPI assigned
- May 30, 2005
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A74550 | CA | Primary |
Addresses
Primary practice location
1920 Tienda Dr
Ste 102
Lodi, CA 95242-3930
Mailing address
1920 Tienda Dr
Ste 102
Lodi, CA 95242-3930
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A74550 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lodi Children's Clinic Medical Corporation | Past | Accepting new patients | |
| Port City Operating Company, LLC | Past | Accepting new patients | |
| Hill Physicians Medical Group - PPO Program | Past | Accepting new patients | |
| Lodi Memorial Hospital Association Inc | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- ranunciacion15363@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.
-
dba Lodi Children's Clinic
- Primary Care Clinic/Center
- Lodi, CA
- NPI 1235203688
-
- Preferred Provider Organization
- San Ramon, CA
- NPI 1679011035
-
dba Lodi Memorial Hospital Acute Physical Rehabilitation Unit
- Rehabilitation Hospital Unit
- Lodi, CA
- NPI 1821028671
-
dba St. Joseph's Medical Center of Stockton
- General Acute Care Hospital
- Stockton, CA
- NPI 1528190931
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205839735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1920 TIENDA DR",
"address_2": "STE 102",
"city": "LODI",
"state": "CA",
"postal_code": "952423930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1920 TIENDA DR",
"address_2": "STE 102",
"city": "LODI",
"state": "CA",
"postal_code": "952423930",
"telephone_number": "209-368-8310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANUNCIACION",
"first_name": "ROY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A74550",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lodi, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.