NPIMap

Individual provider Active NPI

Abid Christopher Mogannam, M.D., M.B.A.

  • Vascular Surgery Physician
  • San Jose, CA
National Provider Identifier
1598056483
Registry record updated Jan 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
LT15520 Issued in ND
Practice address
2425 Samaritan Dr
San Jose, CA 95124
Phone
(408) 559-2011
NPI assigned
Apr 26, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A123990 CA
Vascular Surgery Physician 2086S0129X LT15520 ND Primary
Vascular Surgery Physician 2086S0129X A123990 CA

Addresses

Primary practice location

2425 Samaritan Dr
San Jose, CA 95124

Mailing address

1900 Camden Ave
Ste 101
San Jose, CA 95124-2944
Phone (408) 899-8272

Other practice location 1

2425 Samaritan Dr
San Jose, CA 95124
Phone (408) 559-2011

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
I20180727002360 CA Practitioner - Vascular SurgeryPractitioner - General Surgery 6002163672 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
University of California, Irvine, California College of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
General Vascular Surgery Medical Group IncGroup PAC ID 1951390137, 5 clinicians

Practice addresses (Care Compare)

13851 E 14TH St
201 202
San Leandro, CA 94578-2631
Phone (510) 347-4700

Hospital & facility affiliations

  • Eden Medical Center Hospital, Castro Valley, CA, CCN 050488
  • St Rose Hospital Hospital, Hayward, CA, CCN 050002
  • Alta Bates Summit Medical Center Hospital, Oakland, CA, CCN 050043
  • Highland Hospital Hospital, Oakland, CA, CCN 050320
  • Alameda Hospital Hospital, Alameda, CA, CCN 050211

Merit-based Incentive Payment System (MIPS)

Final score
91.02 of 100Reported as group
Quality
69.73
Improvement activities
40
Cost
77.1

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal30
Leg revascularization (restoring blood flow)32
Removal of tissue11
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Business Administration, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A123990CAMDSurgery Physician
LT15520NDMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
General Vascular Surgery Medical Group, Inc. Vascular Surgery CurrentSince Jul 1, 2019 Accepting new patients
O'Connor Hospital Past Accepting new patients
County of Santa Clara Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients
California Pacific Medical Group, Inc. Past Accepting new patients
El Camino Hospital Past Accepting new patients
Eden Medical Center/San Leandro Hospital Campus Past Accepting new patients
Centracare Health System - Melrose Past Accepting new patients
Hayward Sisters Hospital Past Accepting new patients
Sutter East Bay Medical Foundation Past Accepting new patients
Alameda Health System Past Accepting new patients
Good Samaritan Hospital Ca LTD PTP Past Accepting new patients

Locations

2070 Clinton Ave
#3
Alameda, CA 94501
Phone (510) 521-4412

2070 Clinton Ave
Fl 3
Alameda, CA 94501
Phone (510) 548-6555

27200 Calaroga Ave
Ste 101
Hayward, CA 94545

27200 Calaroga Ave
Ste 101103
Hayward, CA 94545

13855 E 14th St
#2
San Leandro, CA 94578
Phone (510) 357-4006

13851 E 14th St
Ste 202
San Leandro, CA 94578
Phone (510) 347-4700

2800 Benedict Dr
San Leandro, CA 94577
Phone (510) 357-8300

13851 E 14th St
#201202
San Leandro, CA 94578
Phone (510) 347-4700

100 Park Pl
#150
San Ramon, CA 94583
Phone (925) 275-0551

100 Park Pl
Ste 150
San Ramon, CA 94583
Phone (510) 331-5085

5201 Norris Canyon Rd
Ste 210
San Ramon, CA 94583
Phone (925) 275-0551

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1920/brand/1/csg/1/fhir/r4
  • Direct secure messaging: amogannam452768@hisp.ehr.sutterhealth.org
  • Direct secure messaging: abid.mogannam.1@1920.direct.athenahealth.com

Organizations & group practices 12

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 7

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": "1303776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548201600000",
    "number": "1598056483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 CAMDEN AVE",
            "address_2": "STE 101",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951242944",
            "telephone_number": "408-899-8272",
            "fax_number": "408-442-5767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 SAMARITAN DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95124",
            "telephone_number": "408-559-2011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2425 Samaritan Dr",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "95124",
            "country_code": "US",
            "telephone_number": "408-559-2011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOGANNAM",
        "first_name": "ABID",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "M.D., M.B.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-26",
        "last_updated": "2019-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A123990",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "ND",
            "license": "LT15520",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "A123990",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.