Jiries Peter Mogannam, D.D.S., M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

60191 Issued in CA

Practice address

1111 Sonoma Ave
Suite #220
Santa Rosa, CA 95405-4819

Phone

(707) 566-7300

NPI assigned

Nov 5, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 3, 2019 through Dec 3, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Paul V Sejud DMD PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Santa Rosa, CA
  • NPI 1427138684
  NPD (past)

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

{
    "created_epoch": "1194220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313539200000",
    "number": "1609056878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 SONOMA AVE",
            "address_2": "SUITE #220",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054819",
            "telephone_number": "707-566-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 SONOMA AVE",
            "address_2": "SUITE #220",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054819",
            "telephone_number": "707-566-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOGANNAM",
        "first_name": "JIRIES",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-05",
        "last_updated": "2011-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "60191",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CA",
            "license": "A114965",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah J Mizell, LCSW
• Mobility Masters Northern California Inc.
• Modern Sight Optometric Corporation
• Frank Edward Modic, M.D.
• Cindy Mogannam, MPH, RD, CSP
• Karla Mogollan
• Almira Mogul
• Sophia Moh, OD
• April Mohling
• Guy Stephan Mohr, A.T.

• Oral and Maxillofacial Surgery (Dentist) in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.