Individual provider Active NPI

Michael J Hecimovich, D.O.

  • Diagnostic Radiology Physician
  • Sacramento, CA
National Provider Identifier
1053346833
Registry record updated May 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
5101012044 Issued in MI
Practice address
3161 L St
Sacramento, CA 95816-5234
Phone
(916) 453-9999
Fax
(916) 739-1099
NPI assigned
Jul 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 5101012044 MI Primary

Addresses

Primary practice location

3161 L St
Sacramento, CA 95816-5234

Mailing address

10470 Old Placerville Rd
St 100
Sacramento, CA 95827-2539
Phone (800) 470-0070

Other identifiers 5

IdentifierTypeStateIssuer
4247436MedicaidMI
3056306115OtherMIBCBS PIN #
310D460020OtherMIBCBS GROUP PIN
4247427MedicaidMI
CA3518OtherMIMEDICARE RR GROUP PIN

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
I20110324000087 CA Practitioner - Diagnostic Radiology 2163335340 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Michigan State University College of Osteopathic Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

1 Medical Plaza Dr
Roseville, CA 95661-3037
Phone (916) 454-6868

1640 E Roseville Pkwy
Suite 9
Roseville, CA 95661-3902
Phone (916) 784-2277

1651 Exposition Blvd
Sacramento, CA 95815-5149
Phone (916) 731-7770

1655 Creekside Dr
Folsom, CA 95630-3489
Phone (916) 984-0739

1661 Creekside Dr
Folsom, CA 95630-3489
Phone (916) 984-0739

16911 Willow Glen Rd
Brownsville, CA 95919-9707
Phone (530) 675-2457

1700 Coffee Rd
Modesto, CA 95355-2803
Phone (209) 526-4500

2 Medical Plaza Dr
Roseville, CA 95661-3042

200 Mission Blvd
Jackson, CA 95642-2564
Phone (916) 733-3777

2702 Low CT
Fairfield, CA 94534-9771
Phone (707) 432-2600

2720 Low CT
Fairfield, CA 94534-9771
Phone (707) 428-2731

2800 L St
Sacramento, CA 95816-5616

2825 Capitol Ave
Sacramento, CA 95816-6039
Phone (916) 454-6600

3133 Professional Dr
Auburn, CA 95603-2463
Phone (530) 885-8821

3161 L St
Sacramento, CA 95816-5234
Phone (916) 453-9999

4011 Woodcreek Oaks Blvd
Roseville, CA 95747-6834
Phone (530) 649-3338

440 Plumas Blvd
Yuba City, CA 95991-5071
Phone (530) 749-3409

444 Plumas Blvd
Yuba City, CA 95991-5071
Phone (530) 749-3420

800 E Washington Blvd
Crescent City, CA 95531-8359
Phone (707) 464-8511

8118 Timberlake Way
Sacramento, CA 95823-5400
Phone (916) 681-8852

Hospital & facility affiliations

  • Sutter Auburn Faith Hospital Hospital, Auburn, CA, CCN 050498
  • Sutter Medical Center, Sacramento Hospital, Sacramento, CA, CCN 050108
  • Sutter Roseville Medical Center Hospital, Roseville, CA, CCN 050309
  • Sutter Amador Hospital Hospital, Jackson, CA, CCN 050014
  • Sutter Davis Hospital Hospital, Davis, CA, CCN 050537

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101012044MIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation Diagnostic Radiology Current Accepting new patients
Kellam & Associates, P. C. Diagnostic Radiology Past Accepting new patients

Locations

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

Interoperability endpoints

  • Direct secure messaging: mhecimovichdo77930@hisp.ehr.sutterhealth.org

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431302400000",
    "number": "1053346833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10470 OLD PLACERVILLE RD",
            "address_2": "ST 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272539",
            "telephone_number": "800-470-0070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3161 L ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958165234",
            "telephone_number": "916-453-9999",
            "fax_number": "916-739-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HECIMOVICH",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2015-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "5101012044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4247436",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN #",
            "identifier": "3056306115",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP PIN",
            "identifier": "310D460020",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4247427",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR GROUP PIN",
            "identifier": "CA3518",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.