NPIMap

Individual provider Active NPI

Sunny Koipurathu Philip Jr., M.D.

  • Hematology & Oncology Physician
  • Lodi, CA
National Provider Identifier
1578852109
Registry record updated Feb 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
A151375 Issued in CA
Practice address
801 S Ham LN Ste S
Lodi, CA 95242-7503
Phone
(209) 366-2616
Fax
(209) 333-3884
NPI assigned
Apr 5, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X A151375 CA Primary

Addresses

Primary practice location

801 S Ham LN Ste S
Lodi, CA 95242-7503

Mailing address

2626 N California St Ste B
Stockton, CA 95204-5500
Phone (209) 466-2626

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
I20180208001458 CA Practitioner - Hematology/Oncology 8224398433 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Stockton Hematology Oncology Medical Group IncGroup PAC ID 1456369800, 9 clinicians

Practice addresses (Care Compare)

801 S Ham LN
Suite S
Lodi, CA 95242-7503
Phone (209) 366-2616

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.02 of 100Reported as group
Quality
71.01
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A151375CAMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Twain Medical Center CurrentSince Mar 14, 2020 Accepting new patients
Stockton Hematology Oncology Medical Group, Inc Hematology & Oncology CurrentSince Dec 24, 2017 Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
Port City Operating Company, LLC Past Accepting new patients
Hill Physicians Medical Group - PPO Program Past Accepting new patients
Sutter Tracy Community Hospital Past Accepting new patients

Locations

801 S Ham Ln
Ste S
Lodi, CA 95242
Phone (209) 333-8066

801 S Ham Ln
Ste 5
Lodi, CA 95242
Phone (209) 333-8066

300 Northgate Dr
Manteca, CA 95336
Phone (209) 665-4782

300 Northgate Dr
Ste S
Manteca, CA 95336

1325 Melrose Ave
Ste A
Modesto, CA 95350
Phone (209) 524-7000

768 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 464-6422

2626 N California St
Ste B
Stockton, CA 95204
Phone (209) 466-2626

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir.prod.flatiron.io/fhir/

Organizations & group practices 6

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 5

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": "1301961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518480000000",
    "number": "1578852109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2626 N CALIFORNIA ST STE B",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952045500",
            "telephone_number": "209-466-2626",
            "fax_number": "209-466-7153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S HAM LN STE S",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952427503",
            "telephone_number": "209-366-2616",
            "fax_number": "209-333-3884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILIP",
        "first_name": "SUNNY",
        "middle_name": "KOIPURATHU",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-05",
        "last_updated": "2018-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CA",
            "license": "A151375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lodi, CA

Sources for this page

Verify at the official NPI Registry.