NPIMap

Individual provider Active NPI

John Charles Merillat, MD

  • Cardiovascular Disease Physician
  • Modesto, CA
National Provider Identifier
1346280229
Registry record updated Jan 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
G67546 Issued in CA
Practice address
1540 Florida Ave Ste 100
Modesto, CA 95350-4430
Phone
(209) 577-5557
Fax
(209) 579-7246
NPI assigned
Jun 7, 2006
Last updated
Jan 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology Physician 207RC0001X G67546 CA
Interventional Cardiology Physician 207RI0011X G67546 CA
Cardiovascular Disease Physician 207RC0000X G67546 CA Primary

Addresses

Primary practice location

1540 Florida Ave Ste 100
Modesto, CA 95350-4430

Mailing address

1540 Florida Ave Ste 100
Modesto, CA 95350-4430
Phone (209) 577-5557

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ76734ZMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, GU2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080522000258 CA Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology) 0143243915 Reassigns benefits to 1 organization
I20151002001817 GU Practitioner - Cardiovascular Disease (Cardiology) 0143243915 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac Electrophysiology
Education
University of Kansas School of Med (KC/Wich/Sal), 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Heart Associates Medical Group IncGroup PAC ID 1254354111, 10 clinicians

Practice addresses (Care Compare)

1051 E Tuolumne Rd
Suite 101
Turlock, CA 95382-1546
Phone (209) 632-2200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.35 of 100Reported as group
Quality
88.32
Improvement activities
40
Cost
77.64

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10
Pacemaker insertion or repair18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
67546CAMDPharmacist
G67546CAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Guam Memorial Hospital CurrentSince Sep 4, 2015 Accepting new patients
Guam Memorial Hospital CurrentSince Sep 4, 2015 Accepting new patients
Doctors Medical Center of Modesto Past Accepting new patients

Locations

850 Gov Carlos G Camacho Rd
Tamuning, GU 96913
Phone (671) 647-2555

850 Gov Carlos G Camacho Rd
#R
Tamuning, GU 96913
Phone (671) 647-2552

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: john.merillat.p1@direct.vhamg.nextgenshare.com
  • Direct secure messaging: john.merillat.p107@direct.tenet.nextgenshare.com

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.

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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610668800000",
    "number": "1346280229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 FLORIDA AVE STE 100",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504430",
            "telephone_number": "209-577-5557",
            "fax_number": "209-579-7246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 FLORIDA AVE STE 100",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504430",
            "telephone_number": "209-577-5557",
            "fax_number": "209-579-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERILLAT",
        "first_name": "JOHN",
        "middle_name": "CHARLES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "CA",
            "license": "G67546",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CA",
            "license": "G67546",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "G67546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ76734Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.