NPIMap

Individual provider Active NPI

Pericles Ioannides, M.D.

  • Radiation Oncology Physician
  • Sonora, CA
National Provider Identifier
1386007367
Registry record updated Jun 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
A154867 Issued in CA
Practice address
900 Mono Way
Sonora, CA 95370-5229
Phone
(209) 536-6915
NPI assigned
Mar 29, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X A154867 CA Primary

Addresses

Primary practice location

900 Mono Way
Sonora, CA 95370-5229

Mailing address

900 Mono Way
Sonora, CA 95370-5229
Phone (209) 536-6915

Other practice location 1

2407 W Vine St
Lodi, CA 95242-3730
Phone (209) 333-3056

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
I20210921003858 CA Practitioner - Radiation Oncology 2567726938 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Indiana University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sonora Community HospitalGroup PAC ID 4284538505, 134 clinicians

Practice addresses (Care Compare)

900 Mono Way
Sonora, CA 95370-5229
Phone (209) 536-6925

Hospital & facility affiliations

  • Adventist Health Sonora Hospital, Sonora, CA, CCN 050335
  • Mark Twain Medical Center Hospital, San Andreas, CA, CCN 051332
  • Stanford Health Care Hospital, Stanford, CA, CCN 050441
  • University of California Davis Medical Center Hospital, Sacramento, CA, CCN 050599

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

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sonora Community Hospital CurrentSince Sep 7, 2021 Accepting new patients
Adventist Health Physicians Network Current Accepting new patients
Adventist Health Physicians Network CurrentSince Jan 21, 2022 Accepting new patients
Adventist Health Physicians Network CurrentSince Jan 21, 2022 Accepting new patients
Sonora Community Hospital CurrentSince Sep 7, 2021 Accepting new patients
Sonora Community Hospital Past Accepting new patients
Sonora Community Hospital Past Accepting new patients

Locations

2407 W Vine St
Lodi, CA 95242
Phone (209) 333-3056

1000 Greenley Rd
Sonora, CA 95370
Phone (209) 263-0803

900 Mono Way
Sonora, CA 95370
Phone (209) 536-6925

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

Organizations & group practices 7

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 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1459209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654214400000",
    "number": "1386007367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 MONO WAY",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705229",
            "telephone_number": "209-536-6915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 MONO WAY",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705229",
            "telephone_number": "209-536-6915"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2407 W Vine St",
            "address_purpose": "LOCATION",
            "city": "Lodi",
            "state": "CA",
            "postal_code": "952423730",
            "country_code": "US",
            "telephone_number": "209-333-3056",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IOANNIDES",
        "first_name": "PERICLES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-29",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "CA",
            "license": "A154867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sonora, CA

Sources for this page

Verify at the official NPI Registry.