NPIMap

Individual provider Active NPI

Peter Minh Phan, MD

  • Nuclear Medicine Physician
  • Aliso Viejo, CA
National Provider Identifier
1811195563
Registry record updated Sep 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nuclear Medicine PhysicianTaxonomy code 207U00000X
License
2007018365 Issued in MO
Practice address
9 Goldenrain
Aliso Viejo, CA 92656-2118
Phone
(949) 716-0949
Fax
(949) 716-1105
NPI assigned
Jul 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Medicine Physician 207U00000X 2007018365 MO Primary
Diagnostic Radiology Physician 2085R0202X A91299 CA

Addresses

Primary practice location

9 Goldenrain
Aliso Viejo, CA 92656-2118

Mailing address

9 Goldenrain
Aliso Viejo, CA 92656-2118
Phone (949) 716-0949

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
I20080612000341 CA Practitioner - Diagnostic RadiologyPractitioner - Nuclear Medicine 5991881211 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of California, San Diego School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of Santa ClaraGroup PAC ID 1254244973, shared by 46 NPIs, 1,000 clinicians

Practice addresses (Care Compare)

2101 Alexian Dr
San Jose, CA 95116-1901
Phone (408) 272-6050

2325 Enborg Lane
San Jose, CA 95128-2604

7475 Camino Arroyo
Gilroy, CA 95020-7348
Phone (408) 885-5000

751 S Bascom Ave
San Jose, CA 95128-2604
Phone (408) 885-5000

9400 N Name Uno
Gilroy, CA 95020-3528
Phone (408) 885-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
61 of 100Reported as group
Quality
59.41
Promoting interoperability
0
Improvement activities
40
Cost
71.45

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
91299CAMDClinical Social Worker
2007018365MOMDNuclear Medicine Physician
A91299CAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Santa Clara CurrentSince Aug 10, 2019 Accepting new patients
County of Santa Clara CurrentSince Feb 22, 2012 Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara CurrentSince Aug 10, 2019 Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara CurrentSince Feb 22, 2012 Accepting new patients
Medical Imaging Physicians Inc Diagnostic Radiology Past Accepting new patients
Richland Memorial Hospital, Inc PastSince May 31, 2010 Accepting new patients
Renaissance Radiology Medical Group, Inc. Diagnostic Radiology Past Accepting new patients

Locations

7475 Camino Arroyo
Gilroy, CA 95020
Phone (408) 852-2400

1996 Lundy Ave
San Jose, CA 95131
Phone (408) 299-5846

500 Tully Rd
San Jose, CA 95111
Phone (408) 817-1433

750 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-2320

750 S Bascom Ave
#1112
San Jose, CA 95128

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

1993 McKee Rd
San Jose, CA 95116
Phone (408) 254-6320

2101 Alexian Dr
San Jose, CA 95116
Phone (408) 272-6050

660 S Fair Oaks Ave
Sunnyvale, CA 94086
Phone (408) 885-7366

Interoperability endpoints

  • Direct secure messaging: pphan11315@santaclaravalley.direct-ci.net

Organizations & group practices 9

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.

Hospital & facility affiliations 11

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": "1183507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253059200000",
    "number": "1811195563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 GOLDENRAIN",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926562118",
            "telephone_number": "949-716-0949",
            "fax_number": "949-716-1105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 GOLDENRAIN",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926562118",
            "telephone_number": "949-716-0949",
            "fax_number": "949-716-1105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "PETER",
        "middle_name": "MINH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-04",
        "last_updated": "2009-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "MO",
            "license": "2007018365",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A91299",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aliso Viejo, CA

Sources for this page

Verify at the official NPI Registry.