NPIMap

Organization Active NPI

Medical Vision Technology Ophthalmology Medical Group Inc.

  • Ophthalmology Physician
  • Sacramento, CA
National Provider Identifier
1013940519
Registry record updated Jan 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MEDICAL VISION TECHNOLOGY OPHTHALMOLOGY MEDICAL GROUP INC.
Practice address
1700 Alhambra Blvd
Suite 202
Sacramento, CA 95816-7050
Phone
(916) 731-8040
Fax
(916) 454-4152
NPI assigned
Jul 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2022

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

Authorized official

Name
Maura Lynn Stonham
Title
Billing/Credentialing Manager
Phone
(916) 731-5955

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary
Ophthalmic Plastic and Reconstructive Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207WX0200X

Addresses

Primary practice location

1700 Alhambra Blvd
Suite 202
Sacramento, CA 95816-7050

Mailing address

1700 Alhambra Blvd
Suite 202
Sacramento, CA 95816-7050
Phone (916) 731-8040

Other identifiers 1

IdentifierTypeStateIssuer
GR0042240MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040608001193 CA Part B Supplier - Clinic/Group Practice 2668455031 Receives reassigned benefits from 12 practitioners
2 other NPIs on this enrollment
Practice locations: Roseville, CA; Sacramento, CA
O20100930064603 CA DME Supplier - Physician - Ophthalmology 2668455031 Practice locations: Sacramento, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Medical Vision Technology Ophthalmology Medical GRP Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1830 Sierra Gardens Dr
Ste 100
Roseville, CA 95661
Phone (916) 782-2111

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642377600000",
    "number": "1013940519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 ALHAMBRA BLVD",
            "address_2": "SUITE 202",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958167050",
            "telephone_number": "916-731-8040",
            "fax_number": "916-454-4152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 ALHAMBRA BLVD",
            "address_2": "SUITE 202",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958167050",
            "telephone_number": "916-731-8040",
            "fax_number": "916-454-4152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL VISION TECHNOLOGY OPHTHALMOLOGY MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2022-01-17",
        "certification_date": "2022-01-17",
        "status": "A",
        "authorized_official_last_name": "STONHAM",
        "authorized_official_first_name": "MAURA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "BILLING/CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "916-731-5955"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207WX0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0042240",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2022; 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.