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DR. JIRIES PETER MOGANNAM D.D.S., M.D.
NPI 1609056878
Dentist - Oral and Maxillofacial Surgery in Santa Rosa, CA

Active since November 05, 2007Opted out of Medicare · through Dec 3, 2027
1111 SONOMA AVE, SUITE #220, SANTA ROSA, CA 95405(707) 566-7300 Get Directions Write a Review

NPPES record last updated: August 17, 2011. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Jiries Peter Mogannam D.d.s., M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JIRIES PETER MOGANNAM D.D.S., M.D. (NPI 1609056878) is an individual oral and maxillofacial surgery provider in Santa Rosa, California, licensed in California (60191) and active in the NPI registry since November 2007. He has opted out of Medicare through December 3, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1609056878
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameDR. JIRIES PETER MOGANNAMCredential: D.D.S., M.D.
Location Address1111 SONOMA AVE, SUITE #220Santa Rosa, CA 95405-4819
Mailing Address1111 Sonoma Ave, Suite #220Santa Rosa, CA 95405-4819 · (707) 566-7300
Phone(707) 566-7300
Sole ProprietorYes
Enumeration DateNovember 5, 2007
Last NPPES UpdateAugust 17, 2011
✔ NPI 1609056878 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in CA · 60191
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
Also ListedOral & Maxillofacial SurgeryTaxonomy 204E00000X · License A114965 (CA)
1111 SONOMA AVE, Santa Rosa, CA 95405
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Jiries Peter Mogannam D.d.s., M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from December 3, 2019 through December 3, 2027.

Opt-Out Effective DateDecember 3, 2019
Opt-Out In Effect ThroughDecember 3, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95405 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.16 typical visit price
range $63.04 – $187.01
Typical copayment $24.04 (range $15.76 – $46.75)
Most-billed visit code 99203
Established Patient
$77.94 typical visit price
range $21.02 – $153.40
Typical copayment $19.48 (range $5.25 – $38.35)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NORTHERN CALIFORNIA MEDICAL ASSOC
Orthopaedic Surgery (Hand Surgery)
1111 SONOMA AVE, STE 202
SANTA ROSA, CA 95405
Sonoma County (707) 546-7400
EMMA SUSAN WILLIAMSON CNM
Midwife
1111 SONOMA AVE, STE 316
SANTA ROSA, CA 95405
Sonoma County (707) 575-9167
DR. ROGER A KLEIN M.D.
Orthopaedic Surgery
1111 SONOMA AVE, SUITE 106
SANTA ROSA, CA 95405
Sonoma County (707) 576-0366
DREW HITTENBERGER AND ASSOCIATES
Orthotic Fitter
1111 SONOMA AVE, SUITE 106
SANTA ROSA, CA 95405
Sonoma County (707) 765-1122
SANTA ROSA CARDIAC IMAGING
Nuclear Medicine (Nuclear Cardiology)
1111 SONOMA AVE, SUITE 108
SANTA ROSA, CA 95405
Sonoma County (707) 636-0190
DR. ROBERT EARLE SWEAT M.D.
Specialist
1111 SONOMA AVE, SUITE 320
SANTA ROSA, CA 95405
Sonoma County (707) 348-3013
PATRICK G DEVLIN MD A MEDICAL CORPORATION
Specialist
1111 SONOMA AVE, SUITE 302
SANTA ROSA, CA 95405
Sonoma County (707) 545-7300
PETER J MARINCOVICH
Audiologist
1111 SONOMA AVE, SUITE 316
SANTA ROSA, CA 95405
Sonoma County (707) 523-4740

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jiries Mogannam's NPI number?

The NPI number for Jiries Mogannam is 1609056878. It was assigned to this individual provider in the NPPES registry on November 5, 2007.

Where is Jiries Mogannam located?

Jiries Mogannam practices at 1111 Sonoma Ave Suite #220, Santa Rosa, CA 95405. The listed phone number is (707) 566-7300.

What is Jiries Mogannam's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Jiries Mogannam enrolled in Medicare?

No. Jiries Mogannam has opted out of Medicare through December 3, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Jiries Mogannam was last updated on August 17, 2011. NPI Profile syncs with the weekly NPPES data releases published by CMS.