Individual provider Active NPI

Ruben Corral Fragoso, MD, PHD

  • Radiation Oncology Physician
  • Sacramento, CA
National Provider Identifier
1417154436
Registry record updated Jan 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
A109259 Issued in CA
Practice address
4501 X St
Suite 0156
Sacramento, CA 95817-2229
Phone
(916) 734-8276
Fax
(916) 703-5069
NPI assigned
Jul 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X MT187129 PA
Radiation Oncology Physician 2085R0001X A109259 CA Primary

Addresses

Primary practice location

4501 X St
Suite 0156
Sacramento, CA 95817-2229

Mailing address

854 8TH Ave
Sacramento, CA 95818-4039
Phone (617) 869-4409

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
I20091022000048 CA Practitioner - Radiation Oncology 2668519760 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Harvard Medical School, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Regents of the Univ of CaGroup PAC ID 3375456619, 1,571 clinicians

Practice addresses (Care Compare)

3850 G St
Merced, CA 95340-8787
Phone (209) 384-6528

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.15 of 100Reported as group
Quality
64.8
Promoting interoperability
100
Improvement activities
40
Cost
68.65

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A109259CAMDRadiation Oncology Physician
MT187129PAMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the Univ of Ca CurrentSince Aug 26, 2009 Accepting new patients
Regents of the Univ of Ca CurrentSince Aug 26, 2009 Accepting new patients
Regents of the Univ of Ca Current Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients

Locations

3850 G St
Merced, CA 95340
Phone (209) 384-6528

4501 X St
Fl 2
Sacramento, CA 95817
Phone (916) 734-5959

4900 Broadway
Ste 2800
Sacramento, CA 95820
Phone (916) 734-9313

4501 X St
Ste 156
Sacramento, CA 95817
Phone (916) 734-8276

4501 X St
Sacramento, CA 95817
Phone (916) 734-5959

4860 Y St
Sacramento, CA 95817
Phone (916) 734-2700

Organizations & group practices 5

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 3

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": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1417154436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "854 8TH AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958184039",
            "telephone_number": "617-869-4409",
            "fax_number": "916-703-5069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 X ST",
            "address_2": "SUITE 0156",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172229",
            "telephone_number": "916-734-8276",
            "fax_number": "916-703-5069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRAGOSO",
        "first_name": "RUBEN",
        "middle_name": "CORRAL",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-02",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "PA",
            "license": "MT187129",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "CA",
            "license": "A109259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.