NPIMap

Individual provider Active NPI

John Porteous, MD

  • Surgery Physician
  • Modesto, CA
National Provider Identifier
1669460630
Registry record updated Mar 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
C2981 Issued in CA
Practice address
1541 Florida Ave
Suite 200
Modesto, CA 95350-4429
Phone
(209) 577-3388
Fax
(209) 523-0764
NPI assigned
Oct 12, 2005
Last updated
Mar 29, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2011

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X C2981 CA Primary
Trauma Surgery Physician 2086S0127X C2981 CA
Vascular Surgery Physician 2086S0129X C2981 CA
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X C2981 CA

Addresses

Primary practice location

1541 Florida Ave
Suite 200
Modesto, CA 95350-4429

Mailing address

1541 Florida Ave
Suite 200
Modesto, CA 95350-4429
Phone (209) 577-3388

Other identifiers 4

IdentifierTypeStateIssuer
CD069AOtherCAMEDICARE GROUP PTAN
020013716OtherCARAILROAD MEDICARE
CF369ZOtherCAMEDICARE INDIVIDUAL PTAN
ZZZ48224ZOtherCAMEDICARE IDENTIFICATION #

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

State licenses

LicenseStateTypeSpecialty
C2981CAMDTrauma Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Modesto Medical Surgical Associates, Inc. Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301356800000",
    "number": "1669460630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 FLORIDA AVE",
            "address_2": "SUITE 200",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504429",
            "telephone_number": "209-577-3388",
            "fax_number": "209-523-0764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 FLORIDA AVE",
            "address_2": "SUITE 200",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504429",
            "telephone_number": "209-577-3388",
            "fax_number": "209-523-0764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTEOUS",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2011-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "C2981",
            "primary": true
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "CA",
            "license": "C2981",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "C2981",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "C2981",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "CD069A",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "020013716",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL PTAN",
            "identifier": "CF369Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE IDENTIFICATION #",
            "identifier": "ZZZ48224Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.