NPIMap

Organization Active NPI

Pinnacle Sjir

  • Diagnostic Radiology Physician
  • Manteca, CA
National Provider Identifier
1437705456
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PINNACLE SJIR
Practice address
145 Trevino Ave
Manteca, CA 95337-4200
Phone
(209) 788-8180
Fax
(209) 783-0036
NPI assigned
Aug 15, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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

Authorized official

Name
David SotoNPI 1386885382
Title
Medical Director
Phone
(209) 788-8180

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

145 Trevino Ave
Manteca, CA 95337-4200

Mailing address

145 Trevino Ave
Manteca, CA 95337-4200
Phone (209) 756-4832

Other identifiers 1

IdentifierTypeStateIssuer
2085R0202XOtherTAXONOMY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200512003087 CA Part B Supplier - Clinic/Group Practice 9638500374 Receives reassigned benefits from 12 practitioners
Practice locations: Manteca, CA; Turlock, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1565827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640131200000",
    "number": "1437705456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 TREVINO AVE",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953374200",
            "telephone_number": "209-756-4832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 TREVINO AVE",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953374200",
            "telephone_number": "209-788-8180",
            "fax_number": "209-783-0036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINNACLE SJIR",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-15",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A",
        "authorized_official_last_name": "SOTO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "209-788-8180"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "2085R0202X",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manteca, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; 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.