NPIMap

Individual provider Active NPI

Masato Sugiura, DO

  • Student in an Organized Health Care Education/Training Program
  • Scranton, PA
National Provider Identifier
1801220710
Registry record updated Nov 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
501 Madison Avenue
Tobin Hall
Scranton, PA 18510
Phone
(570) 343-2383
NPI assigned
Aug 27, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 10, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OT015563 PA
Student in an Organized Health Care Education/Training Program 390200000X PA Primary

Addresses

Primary practice location

501 Madison Avenue
Tobin Hall
Scranton, PA 18510

Mailing address

501 Madison Avenue
Tobin Hall
Scranton, PA 18510
Phone (570) 343-2383

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address msugiura1658372@oc.providencedirect.org

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
I20160914002375 CA Practitioner - Family Practice 1254633753 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

1550 A Professional Dr
Suite 200
Petaluma, CA 94954-6628
Phone (707) 769-7403

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Sep 1, 2016 Accepting new patients
Providence Medical Foundation Family Medicine CurrentSince Sep 1, 2016 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation Family Medicine Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 400
Anaheim, CA 92805

2700 Dolbeer St
Eureka, CA 95501
Phone (707) 269-4229

1550 Professional Dr
Ste 200
Petaluma, CA 94954
Phone (707) 769-7403

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

Organizations & group practices 5

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 4

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": "1377561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636502400000",
    "number": "1801220710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 MADISON AVENUE",
            "address_2": "TOBIN HALL",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "18510",
            "telephone_number": "570-343-2383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 MADISON AVENUE",
            "address_2": "TOBIN HALL",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "18510",
            "telephone_number": "570-343-2383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUGIURA",
        "first_name": "MASATO",
        "name_prefix": "Mr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-27",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OT015563",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msugiura1658372@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "2700 Dolbeer St",
            "city": "Eureka",
            "state": "CA",
            "country_code": "US",
            "postal_code": "955014736",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Scranton, PA

Sources for this page

Verify at the official NPI Registry.