NPIMap

Organization Active NPI

Surgical Associates Inc

  • Trauma Surgery Physician
  • Modesto, CA
National Provider Identifier
1366824161
Registry record updated May 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
Legal business name
SURGICAL ASSOCIATES INC
Practice address
1700 Coffee Rd
Modesto, CA 95355-2803
Phone
(209) 661-4403
Fax
(209) 579-5637
NPI assigned
Jun 29, 2015
Last updated
May 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2020

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

Authorized official

Name
Tony Tam, M.D.NPI 1114957628
Title
Owner
Phone
(209) 661-4403

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU
Surgical Critical Care Physician 2086S0102X NU
Trauma Surgery Physician 2086S0127X NU Primary

Addresses

Primary practice location

1700 Coffee Rd
Modesto, CA 95355-2803

Mailing address

220 Standiford Ave Ste F
Modesto, CA 95350-1159
Phone (209) 579-5628

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160215001177 CA Part B Supplier - Clinic/Group Practice 6002110814 Receives reassigned benefits from 36 practitioners
Practice locations: Modesto, CA

National Provider Directory

National Provider Directory

Locations

1401 Spanos Ct
Ste 108
Modesto, CA 95355
Phone (209) 525-3820

Practitioners & affiliated clinicians

Practitioners 36

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1366824161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 STANDIFORD AVE STE F",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953501159",
            "telephone_number": "209-579-5628",
            "fax_number": "209-579-5637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552803",
            "telephone_number": "209-661-4403",
            "fax_number": "209-579-5637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-29",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "TAM",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-661-4403",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.