NPIMap

Sierra ER Department Physicians Medical Group Inc.

Organization Active NPI Emergency Medicine Physician · Susanville, CA

NPI 1033570247 · NPPES record last updated Mar 15, 2016

Key facts

NPI
1033570247
Entity type
Organization (NPI type 2)
Primary specialty
Emergency Medicine Physician 207P00000X
Legal business name
SIERRA ER DEPARTMENT PHYSICIANS MEDICAL GROUP INC.
Practice address
1800 Spring Ridge Dr
Susanville, CA 96130-6100
Phone
(530) 257-5325
NPI assigned
Mar 15, 2016
Organization subpart
No

Authorized official

Name
Kristopher M Smith
Title
Cfo
Phone
(925) 924-1600

Practitioners 61

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 61

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20161021000368 CA Part B Supplier - Clinic/Group Practice 5092093351 Receives reassigned benefits from 59 practitioners
Practice locations: Susanville, CA

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207P00000X Yes
Physician Assistant
Group: 193200000X MULTI-SPECIALTY GROUP		 363A00000X
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363L00000X

Addresses

Primary practice location

1800 Spring Ridge Dr
Susanville, CA 96130-6100

Mailing address

5000 Hopyard Rd
Suite 100
Pleasanton, CA 94588-3348
Phone (925) 924-1600

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 15, 2016.

{
    "created_epoch": "1458000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458000000000",
    "number": "1033570247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 HOPYARD RD",
            "address_2": "SUITE 100",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945883348",
            "telephone_number": "925-924-1600",
            "fax_number": "925-924-0506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 SPRING RIDGE DR",
            "city": "SUSANVILLE",
            "state": "CA",
            "postal_code": "961306100",
            "telephone_number": "530-257-5325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIERRA ER DEPARTMENT PHYSICIANS MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-15",
        "last_updated": "2016-03-15",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KRISTOPHER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "925-924-1600"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Susanville, CA

All providers in Susanville, CA · Emergency Medicine Physician in California

Sources for this page

Verify at the official NPI Registry.