NPIMap

Individual provider Active NPI

Michael Richard Portillo, M.D.

  • Family Medicine Physician
  • Sonora, CA
National Provider Identifier
1306235957
Registry record updated Dec 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A144432 Issued in CA
Practice address
680 Guzzi LN Ste 106
Sonora, CA 95370-5288
Phone
(209) 536-5770
Fax
(209) 536-3596
NPI assigned
Jan 21, 2015
Last updated
Dec 14, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 14, 2017

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 A144432 CA Primary

Addresses

Primary practice location

680 Guzzi LN Ste 106
Sonora, CA 95370-5288

Mailing address

PO Box 655
Twain Harte, CA 95383-0655
Phone (209) 206-2266

Other practice location 1

374 W Olive Ave
Suite A
Merced, CA 95348-3181
Phone (209) 384-5766

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
I20171121001297 CA Practitioner - Family Practice 4981961265 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sonora Community HospitalGroup PAC ID 4284538505, shared by 10 NPIs, 134 clinicians

Practice addresses (Care Compare)

193 Fairview LN
Sonora, CA 95370-4828
Phone (209) 536-5100

680 Guzzi LN
Suite 106
Sonora, CA 95370-5288
Phone (209) 536-5770

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.78 of 100Reported as group
Quality
81.74
Promoting interoperability
97
Improvement activities
40
Cost
67.27

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A144432CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sonora Community Hospital Single Specialty CurrentSince Jan 1, 2021 Accepting new patients
Sonora Community Hospital Single Specialty Current Accepting new patients
Sonora Community Hospital CurrentSince Oct 12, 2017 Accepting new patients
Sonora Community Hospital Single Specialty CurrentSince Oct 12, 2017 Accepting new patients
Sonora Community Hospital Single Specialty Current Accepting new patients
Sonora Community Hospital Single Specialty Past Accepting new patients

Locations

14542 Lolly Ln
Sonora, CA 95370
Phone (209) 536-3625

193 Fairview Ln
Sonora, CA 95370
Phone (209) 536-5100

193 Fairview Ln
Ste B
Sonora, CA 95370
Phone (209) 532-5100

680 Guzzi Ln
Ste 105
Sonora, CA 95370
Phone (209) 532-0126

680 Guzzi Ln
Ste 106
Sonora, CA 95370
Phone (209) 532-2792

680 Guzzi Ln
Ste 201
Sonora, CA 95370
Phone (209) 536-1785

Organizations & group practices 6

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 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1421798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513209600000",
    "number": "1306235957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 655",
            "city": "TWAIN HARTE",
            "state": "CA",
            "postal_code": "953830655",
            "telephone_number": "209-206-2266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 GUZZI LN STE 106",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705288",
            "telephone_number": "209-536-5770",
            "fax_number": "209-536-3596"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "374 W Olive Ave",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Merced",
            "state": "CA",
            "postal_code": "953483181",
            "country_code": "US",
            "telephone_number": "209-384-5766",
            "fax_number": "209-383-4230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PORTILLO",
        "first_name": "MICHAEL",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-21",
        "last_updated": "2017-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A144432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sonora, CA

Sources for this page

Verify at the official NPI Registry.