Active NPI
John D Mast, MD
- Surgery Physician
- Tracy, CA
National Provider Identifier
1508807561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- G34146
- Practice address
- 473 W Eaton Ave
Tracy, CA 95376-3420 - Phone
- (209) 833-3320
- NPI assigned
- Jun 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | G34146 | CA | Primary |
Addresses
Primary practice location
473 W Eaton Ave
Tracy, CA 95376-3420
Mailing address
600 Coffee Rd
Modesto, CA 95355-4201
Phone (209) 521-6097
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G341461 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395619200000",
"number": "1508807561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 COFFEE RD",
"city": "MODESTO",
"state": "CA",
"postal_code": "953554201",
"telephone_number": "209-521-6097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "473 W EATON AVE",
"city": "TRACY",
"state": "CA",
"postal_code": "953763420",
"telephone_number": "209-833-3320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAST",
"first_name": "JOHN",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-09",
"last_updated": "2014-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "G34146",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G341461",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tracy, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.