NPIMap

Organization Active NPI

El Portal Radiation Oncology Center

  • Radiation Oncology Physician
  • Merced, CA
National Provider Identifier
1902062136
Registry record updated Apr 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
EL PORTAL RADIATION ONCOLOGY CENTER
Practice address
3303 M St
Merced, CA 95348-2714
Phone
(209) 726-3371
Fax
(209) 726-3410
NPI assigned
Aug 7, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2018

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

Authorized official

Name
Mr. Alireza Mahmoudieh, MDNPI 1720166309
Title
Medical Director
Phone
(209) 726-3371

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
Radiation Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0001X Primary

Addresses

Primary practice location

3303 M St
Merced, CA 95348-2714

Mailing address

Dept la 23779
Pasadena, CA 91185-3779
Phone (209) 726-3410

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090124000099 CA Part B Supplier - Clinic/Group Practice 3678637378 Receives reassigned benefits from 6 practitioners
Practice locations: Madera, CA; Merced, CA
O20200401003661 TN Part B Supplier - Clinic/Group Practice 3678637378 Receives reassigned benefits from 1 practitioner
Practice locations: Knoxville, TN

National Provider Directory

National Provider Directory

Locations

360 E Almond Ave
#103
Madera, CA 93637
Phone (559) 675-7926

3303 M St
Merced, CA 95348
Phone (209) 384-3533

Dept LA 23779
Pasadena, CA 91185

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 12

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": "1218067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523577600000",
    "number": "1902062136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT LA 23779",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911853779",
            "telephone_number": "209-726-3410",
            "fax_number": "209-726-3371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303 M ST",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953482714",
            "telephone_number": "209-726-3371",
            "fax_number": "209-726-3410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL PORTAL RADIATION ONCOLOGY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-07",
        "last_updated": "2018-04-13",
        "status": "A",
        "authorized_official_last_name": "MAHMOUDIEH",
        "authorized_official_first_name": "ALIREZA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "209-726-3371",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merced, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.