Individual provider Active NPI

Andrew Willis Wertz, MD

  • Neonatal-Perinatal Medicine Physician
  • Sacramento, CA
National Provider Identifier
1013909621
Registry record updated Jun 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
C34429 Issued in CA
Practice address
2825 Capitol Ave FL 1
Sacramento, CA 95816-6039
Phone
(916) 887-0104
Fax
(916) 887-0112
NPI assigned
Aug 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X C34429 CA Primary

Addresses

Primary practice location

2825 Capitol Ave FL 1
Sacramento, CA 95816-6039

Mailing address

2750 Gateway Oaks Dr Ste 150
Sacramento, CA 95833-3668
Phone (916) 887-7398

Other practice location 1

1020 29th St Ste 480
Sacramento, CA 95816-5173
Phone (916) 887-0780

Other practice location 2

1 Medical Plaza Dr
Roseville, CA 95661-3037
Phone (916) 731-1537

Other identifiers 1

IdentifierTypeStateIssuer
00C344290MedicaidCA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120508000209 CA Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 4880798743

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter North Medical Foundation PastSince Dec 15, 2019 Accepting new patients
Perinatal & Pediatric Specialists Medical Group Inc. PastSince Aug 1, 2006 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529020800000",
    "number": "1013909621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 GATEWAY OAKS DR STE 150",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958333668",
            "telephone_number": "916-887-7398",
            "fax_number": "916-503-3886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 CAPITOL AVE FL 1",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958166039",
            "telephone_number": "916-887-0104",
            "fax_number": "916-887-0112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1020 29th St Ste 480",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958165173",
            "country_code": "US",
            "telephone_number": "916-887-0780",
            "fax_number": "916-887-0786",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "CA",
            "postal_code": "956613037",
            "country_code": "US",
            "telephone_number": "916-731-1537",
            "fax_number": "916-731-1538",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WERTZ",
        "first_name": "ANDREW",
        "middle_name": "WILLIS",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2018-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "CA",
            "license": "C34429",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C344290",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.