NPIMap

Individual provider Active NPI

Daryl Ray Dutter, M.D.

  • Family Medicine Physician
  • Ripon, CA
National Provider Identifier
1578568366
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G57233 Issued in CA
Practice address
521 N Wilma Ave Ste a
Ripon, CA 95366-9003
Phone
(209) 599-4211
Fax
(209) 599-4341
NPI assigned
Jun 17, 2005
Last updated
Nov 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G57233 CA Primary

Addresses

Primary practice location

521 N Wilma Ave Ste a
Ripon, CA 95366-9003

Mailing address

450 Glass LN Ste C
Modesto, CA 95356-9287
Phone (209) 342-2300

Other identifiers 3

IdentifierTypeStateIssuer
00G572330MedicaidCA
080009801OtherCARAILROAD MEDICARE
68-0311001OtherCATAX ID

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
I20100312000888 CA Practitioner - Family Practice 3072648203 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio State University College of Medicine, 1983
Medicare assignment
May accept Medicare assignment
Group practices
Ripon Family PhysiciansGroup PAC ID 5496152845, 8 clinicians

Practice addresses (Care Compare)

450 Glass LN
Suite C
Modesto, CA 95356-9287

930 W Main St
Ripon, CA 95366-2325
Phone (209) 599-4221

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G57233CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ripon Family Physicians Family Medicine CurrentSince Aug 1, 2021 Accepting new patients
Doctors Medical Center of Modesto, Inc. Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients

Locations

1421 Oakdale Rd
Modesto, CA 95355
Phone (209) 572-0151

450 Glass Ln
Ste C
Modesto, CA 95356

150 Vera Ave
Ripon, CA 95366
Phone (209) 599-4211

521 N Wilma Ave
Ste A
Ripon, CA 95366
Phone (209) 599-4211

930 W Main St
Ripon, CA 95366
Phone (209) 599-4221

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: ddutter@rfp.ssdirect.aprima.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Bethany Home Society of San Joaquin County, Inc.Ripon, CA, CCN 055662 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 31, 2006
Oct 31, 2006

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1578568366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 GLASS LN STE C",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569287",
            "telephone_number": "209-342-2300",
            "fax_number": "209-524-4240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 N WILMA AVE STE A",
            "city": "RIPON",
            "state": "CA",
            "postal_code": "953669003",
            "telephone_number": "209-599-4211",
            "fax_number": "209-599-4341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUTTER",
        "first_name": "DARYL",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G57233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G572330",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080009801",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "68-0311001",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ripon, CA

Sources for this page

Verify at the official NPI Registry.