NPIMap

Organization Active NPI

San Joaquin Hematology/Oncology, a PC

  • Specialist
  • Tracy, CA
National Provider Identifier
1699744383
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A70883 Issued in CA
Legal business name
SAN JOAQUIN HEMATOLOGY/ONCOLOGY, A PC
Practice address
4600 S Tracy Blvd Ste 108
Tracy, CA 95377-8105
Phone
(209) 839-9115
NPI assigned
Mar 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Dr. Neelesh S Bangalore, MD, PHDNPI 1154326262
Title
Ceo
Phone
(209) 477-2000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X A70883 CA Primary

Addresses

Primary practice location

4600 S Tracy Blvd Ste 108
Tracy, CA 95377-8105

Mailing address

PO Box 7667
Stockton, CA 95267-0667
Phone (209) 477-2000

Other identifiers 6

IdentifierTypeStateIssuer
DC7234OtherCARAILROAD MEDICARE
P00186385OtherCARAILROAD MEDICARE
00A708831OtherCAMEDI-CAL
00A708832MedicaidCA
A708830OtherCAMEDICARE
ZZZ08571ZOtherCABLUE SHIELD

National Provider Directory

National Provider Directory
Tax ID family
San Joaquin Hematology Oncology a PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1699744383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7667",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952670667",
            "telephone_number": "209-477-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 S TRACY BLVD STE 108",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953778105",
            "telephone_number": "209-839-9115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOAQUIN HEMATOLOGY/ONCOLOGY, A PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-15",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "BANGALORE",
        "authorized_official_first_name": "NEELESH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-477-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A70883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC7234",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00186385",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "00A708831",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A708832",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "A708830",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ08571Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tracy, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.