Individual provider Active NPI

Susan R Cordes, M.D.

  • Otolaryngology Physician
  • Stockton, CA
National Provider Identifier
1285668707
Registry record updated Jun 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
G129761 Issued in CA
Practice address
10200 Trinity Pkwy Ste 201
Stockton, CA 95219-7288
Phone
(209) 952-0483
Fax
(209) 478-5785
NPI assigned
Jul 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 01043929A IN
Otolaryngology Physician 207Y00000X G129761 CA Primary

Addresses

Primary practice location

10200 Trinity Pkwy Ste 201
Stockton, CA 95219-7288

Mailing address

1111 Exposition Blvd BLDG 700
Sacramento, CA 95815-4314
Phone (916) 736-3399

Other practice location 1

801 S Ham Ln Ste O
Lodi, CA 95242-7502
Phone (209) 952-0483

Other practice location 2

550 W Eaton Ave Ste 548
Tracy, CA 95376-3422
Phone (209) 952-0483

Other identifiers 1

IdentifierTypeStateIssuer
200167750MedicaidIN

Other names 1

  • Susan R Slakes Former name

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
I20140728002724 CA Practitioner - Otolaryngology 2860597507 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10200 Trinity Pkwy
Suite 201
Stockton, CA 95219-7288
Phone (209) 952-0483

Hospital & facility affiliations

  • St Joseph'S Medical Center of Stockton Hospital, Stockton, CA, CCN 050084
  • Adventist Health Lodi Memorial Hospital, Lodi, CA, CCN 050336
  • Sutter Tracy Community Hospital Hospital, Tracy, CA, CCN 050313
  • Sutter Amador Hospital Hospital, Jackson, CA, CCN 050014

Merit-based Incentive Payment System (MIPS)

Final score
74.25 of 100Reported as group
Quality
51.19
Promoting interoperability
94
Improvement activities
40
Cost
61.73

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G129761CAMDOtolaryngology Physician
01043929AINMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sacramento Ear Nose & Throat Surgical & Medical Group Inc Otolaryngology CurrentSince Aug 3, 2020 Accepting new patients
University Otolaryngology Associates, Inc. Otolaryngology Past Accepting new patients
General Otorhinolaryngological Foundation, Inc. Otolaryngology Past Accepting new patients
Major Hospital Past Accepting new patients

Locations

801 S Ham Ln
Ste O
Lodi, CA 95242
Phone (209) 365-0526

1111 Exposition Blvd
Bldg 700
Sacramento, CA 95815
Phone (916) 736-3399

1111 Exposition Blvd
Ste 700
Sacramento, CA 95815
Phone (916) 736-3399

10200 Trinity Pkwy
Ste 201
Stockton, CA 95219
Phone (209) 952-0483

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: scordes219179@hisp.ehr.sutterhealth.org

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": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593475200000",
    "number": "1285668707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 EXPOSITION BLVD BLDG 700",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958154314",
            "telephone_number": "916-736-3399",
            "fax_number": "916-736-3350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10200 TRINITY PKWY STE 201",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952197288",
            "telephone_number": "209-952-0483",
            "fax_number": "209-478-5785"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 S Ham Ln Ste O",
            "address_purpose": "LOCATION",
            "city": "Lodi",
            "state": "CA",
            "postal_code": "952427502",
            "country_code": "US",
            "telephone_number": "209-952-0483",
            "fax_number": "209-478-5785",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "550 W Eaton Ave Ste 548",
            "address_purpose": "LOCATION",
            "city": "Tracy",
            "state": "CA",
            "postal_code": "953763422",
            "country_code": "US",
            "telephone_number": "209-952-0483",
            "fax_number": "209-478-5785",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORDES",
        "first_name": "SUSAN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IN",
            "license": "01043929A",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "G129761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200167750",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "SLAKES",
            "middle_name": "R",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.