Organization Active NPI

Allergy Medical Group of the North Area Inc.

  • Allergy & Immunology Physician
  • Roseville, CA
National Provider Identifier
1083612980
Registry record updated Apr 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
Legal business name
ALLERGY MEDICAL GROUP OF THE NORTH AREA INC.
Practice address
935 Reserve Dr
Roseville, CA 95678-1340
Phone
(916) 782-7758
Fax
(916) 782-7770
NPI assigned
Jul 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2018

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

Authorized official

Name
Sunil Pushpakumara Perera, MDNPI 1417039371
Title
Ceo Owner
Phone
(916) 782-7758

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207K00000X CA Primary

Addresses

Primary practice location

935 Reserve Dr
Roseville, CA 95678-1340

Mailing address

935 Reserve Dr
Roseville, CA 95678-1340
Phone (916) 782-7758

Other identifiers 2

IdentifierTypeStateIssuer
00A305380OtherCANONE
ZZZ76738ZMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050707000581 CA Part B Supplier - Clinic/Group Practice 6305882788 Receives reassigned benefits from 2 practitioners
Practice locations: Roseville, CA; Sacramento, CA; Yuba City, CA

National Provider Directory

National Provider Directory

Locations

935 Reserve Dr
Roseville, CA 95678
Phone (916) 782-7758

1 Scripps Dr
Ste 105
Sacramento, CA 95825
Phone (916) 925-1056

429 Del Norte Ave
Yuba City, CA 95991
Phone (530) 755-3352

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 9

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

NPI Registry JSON

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522886400000",
    "number": "1083612980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 RESERVE DR",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956781340",
            "telephone_number": "916-782-7758",
            "fax_number": "916-782-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 RESERVE DR",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956781340",
            "telephone_number": "916-782-7758",
            "fax_number": "916-782-7770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLERGY MEDICAL GROUP OF THE NORTH AREA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-13",
        "last_updated": "2018-04-05",
        "status": "A",
        "authorized_official_last_name": "PERERA",
        "authorized_official_first_name": "SUNIL",
        "authorized_official_middle_name": "PUSHPAKUMARA",
        "authorized_official_title_or_position": "CEO OWNER",
        "authorized_official_telephone_number": "916-782-7758",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE",
            "identifier": "00A305380",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ76738Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2018; 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.