NPIMap

Individual provider Active NPI

Ajithkumar A Puthillath, MD

  • Specialist
  • Stockton, CA
National Provider Identifier
1225275233
Registry record updated Jul 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A107213 Issued in CA
Practice address
2626 N California St
Suite B
Stockton, CA 95204-5500
Phone
(209) 466-2626
Fax
(206) 466-2199
NPI assigned
Jan 13, 2009
Last updated
Jul 31, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A107213 CA Primary

Addresses

Primary practice location

2626 N California St
Suite B
Stockton, CA 95204-5500

Mailing address

2626 N California St
Suite B
Stockton, CA 95204-5500
Phone (209) 466-2626

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
I20091002000529 CA Practitioner - Medical Oncology 7810033925 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Medical Oncology
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Stockton Hematology Oncology Medical Group IncGroup PAC ID 1456369800, 9 clinicians
San Joaquin Faculty Medical GroupGroup PAC ID 4082631395, 126 clinicians

Practice addresses (Care Compare)

2626 N California St
Suite B
Stockton, CA 95204-5500
Phone (209) 466-2626

500 W Hospital Rd
French Camp, CA 95231-9693
Phone (209) 468-6600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.02 of 100Reported as group
Quality
71.01
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
107213CAMDClinical Social Worker
A107213CAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Twain Medical Center CurrentSince Mar 14, 2020 Accepting new patients
Stockton Hematology Oncology Medical Group, Inc Specialist CurrentSince Aug 1, 2009 Accepting new patients
St. Joseph's Hospital, Yonkers Past Accepting new patients
Hill Physicians Medical Group - PPO Program Past Accepting new patients
Lodi Memorial Hospital Association Inc Past Accepting new patients
St Joseph Hospital of Orange Past Accepting new patients

Locations

500 W Hospital Rd
French Camp, CA 95231
Phone (209) 468-6000

801 S Ham Ln
Ste S
Lodi, CA 95242
Phone (209) 333-8066

300 Northgate Dr
Manteca, CA 95336
Phone (209) 665-4782

768 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 464-6422

2626 N California St
#3
Stockton, CA 95204

2626 N California St
Ste B
Stockton, CA 95204
Phone (209) 466-2626

2626 N California St
Ste H
Stockton, CA 95204

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir.prod.flatiron.io/fhir/

Organizations & group practices 8

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 5

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": "1231804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406764800000",
    "number": "1225275233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2626 N CALIFORNIA ST",
            "address_2": "SUITE B",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952045500",
            "telephone_number": "209-466-2626",
            "fax_number": "209-466-2199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2626 N CALIFORNIA ST",
            "address_2": "SUITE B",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952045500",
            "telephone_number": "209-466-2626",
            "fax_number": "206-466-2199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUTHILLATH",
        "first_name": "AJITHKUMAR",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-13",
        "last_updated": "2014-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A107213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.