Sanaz Stacy Aboutalebi-Simon, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

12259T Issued in CA

Practice address

3400 Delta Fair Blvd
The Permanente Medical Group, Inc.
Antioch, CA 94509-4004

Phone

(925) 779-5223

Fax

(925) 779-5421

NPI assigned

Jul 24, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Stacy Aboutalebi Other name

Electronic endpoints 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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Michael W Ottati, Jr., O.D. Inc

  • Optometrist
  • Antioch, CA
  • NPI 1164406302
  NPD (past)

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1033319215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2640 BUENA VISTA AVE",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945972502",
            "telephone_number": "925-726-9711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 DELTA FAIR BLVD",
            "address_2": "THE PERMANENTE MEDICAL GROUP, INC.",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945094004",
            "telephone_number": "925-779-5223",
            "fax_number": "925-779-5421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABOUTALEBI-SIMON",
        "first_name": "SANAZ",
        "middle_name": "STACY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-24",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "12259T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3400 Delta Fair Blvd",
            "address_2": "The Permanente Medical Group, Inc.",
            "city": "Antioch",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945094004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "ABOUTALEBI",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Krystal Denice Aceves Ochoa
• Rose Chinasa Acholonu
• Ackerman & Towson

• Corneal and Contact Management Optometrist in Antioch, CA
• Providers in Antioch, CA by specialty
• Corneal and Contact Management Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.