NPIMap

Organization Active NPI

Sierra Vista Medical Associates LLC

  • Family Medicine Physician
  • Reno, NV
National Provider Identifier
1104089614
Registry record updated Jul 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1125 Issued in NV
Legal business name
SIERRA VISTA MEDICAL ASSOCIATES LLC
Practice address
1180 Selmi Dr Suite 201
Reno, NV 89512-4776
Phone
(775) 250-7636
NPI assigned
Jul 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2008

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

Authorized official

Name
Douglas Vacek, DO
Title
Owner
Phone
(775) 250-7636

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 1125 NV Primary

Addresses

Primary practice location

1180 Selmi Dr Suite 201
Reno, NV 89512-4776

Mailing address

1180 Selmi Dr Suite 201
Reno, NV 89512-4776
Phone (775) 250-7636

Other identifiers 1

IdentifierTypeStateIssuer
100501342MedicaidNV

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215043200000",
    "number": "1104089614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 SELMI DR SUITE 201",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895124776",
            "telephone_number": "775-250-7636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 SELMI DR SUITE 201",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895124776",
            "telephone_number": "775-250-7636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIERRA VISTA MEDICAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-03",
        "last_updated": "2008-07-03",
        "status": "A",
        "authorized_official_last_name": "VACEK",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "775-250-7636",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "1125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100501342",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.