Taeho Im, MD INC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

G66753 Issued in CA

Practice address

1700 Coffee Rd
Modesto, CA 95355

Phone

(209) 526-4500

NPI assigned

Aug 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Anesthesiology

Education

Loma Linda University School of Medicine, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Medical Center Hospital, Modesto, CA, CCN 050557

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Taeho Im MD Inc

  • Anesthesiology Physician
  • Modesto, CA
  • NPI 1053486498
  Medicare reassignment NPD Authorized official
• Core Anesthesia Provider Services PC

  • Anesthesiology Physician
  • Stockton, CA
  • NPI 1538800388
  Medicare reassignment NPD
• Regional Anesthesia Associates Inc

  • Anesthesiology Physician
  • Bakersfield, CA
  • NPI 1811442874
  Medicare reassignment NPD
• Sutter Valley Hospitals

  • General Acute Care Hospital
  • Modesto, CA
  • NPI 1699129601
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sutter Valley Hospitals

  • General Acute Care Hospital
  • Modesto, CA
  • NPI 1699129601
  Care Compare affiliation

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1841203288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "446 SELBY LN",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945516346",
            "telephone_number": "209-480-3450",
            "fax_number": "209-529-6610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "95355",
            "telephone_number": "209-526-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IM",
        "first_name": "TAEHO",
        "credential": "MD INC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G66753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G667530",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Waleed Abdul Ibrahim, M.D.
• Sayed Mansoor Ibrahimi
• Jayanthi Idury
• Elmer Pedere Ignacio, M.D.
• Yulia Ikuta
• Kaitlyn W. Imada
• Keira Imada
• Kenneth Imanaka, MD
• Laura Imanaka
• Matthew Imanaka

• Anesthesiology Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.