NPIMap

Organization Active NPI

Vitreo-Retinal Medical Group, Inc.

Doing business as Retina Center of Stockton, Inc.

  • Ophthalmology Physician
  • Stockton, CA
National Provider Identifier
1083707822
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
VITREO-RETINAL MEDICAL GROUP, INC.
Doing business as
Retina Center of Stockton, Inc.
Practice address
3555 Deer Park Dr
Suite 180
Stockton, CA 95219-2377
Phone
(209) 938-0496
Fax
(209) 951-5231
NPI assigned
Oct 2, 2006
Last updated
Oct 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

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

Authorized official

Name
Dr. Joel Pearlman, MD
Title
President
Phone
(916) 596-2027

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

3555 Deer Park Dr
Suite 180
Stockton, CA 95219-2377

Mailing address

3 Park Center Dr Ste 100
Sacramento, CA 95825-8340
Phone (916) 514-5469

Other identifiers 5

IdentifierTypeStateIssuer
CP5300OtherCARAILROAD MEDI-CARE
GR0030322MedicaidCA
ZZZ14095ZOtherCAWORKERS COMP.
0199873OtherWADEPT OF LABOR WA
ZZZ14095ZOtherCABLUE SHIELD CA

Other names 1

  • Retina Center of Stockton, Inc. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050427000951 CA Part B Supplier - Clinic/Group Practice 5799672275 Receives reassigned benefits from 23 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Yuba City, CA; Tracy, CA; Fairfield, CA; Stockton, CA; Sacramento, CA; Roseville, CA; Merced, CA; Grass Valley, CA…

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Retinal Cons Med GRP in12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

3555 Deer Park Dr
Ste 180
Stockton, CA 95219
Phone (209) 461-3390

Practitioners & affiliated clinicians

Practitioners 4

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": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1083707822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 PARK CENTER DR STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958258340",
            "telephone_number": "916-514-5469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 DEER PARK DR",
            "address_2": "SUITE 180",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952192377",
            "telephone_number": "209-938-0496",
            "fax_number": "209-951-5231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITREO-RETINAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A",
        "authorized_official_last_name": "PEARLMAN",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-596-2027",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDI-CARE",
            "identifier": "CP5300",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030322",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMP.",
            "identifier": "ZZZ14095Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR WA",
            "identifier": "0199873",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD CA",
            "identifier": "ZZZ14095Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Retina Center of Stockton, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Retina Center of Stockton, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; 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.