NPIMap

Organization Active NPI

Regents of the University of Ca

  • Pediatric Critical Care Medicine Physician
  • Sacramento, CA
National Provider Identifier
1104815067
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
Legal business name
REGENTS OF THE UNIVERSITY OF CA
Practice address
2521 Stockton Blvd
Sacramento, CA 95817-2207
Phone
(916) 734-3179
Fax
(916) 456-2236
NPI assigned
Oct 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

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

Authorized official

Name
Tammy Trovatten
Title
Vice President, Gov'T Reimbursement
Phone
(916) 855-2315

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0203X Primary

Addresses

Primary practice location

2521 Stockton Blvd
Sacramento, CA 95817-2207

Mailing address

10850 White Rock Rd
Rancho Cordova, CA 95670-6044
Phone (916) 734-9200

Other identifiers 5

IdentifierTypeStateIssuer
CR0028OtherCARAILROAD MEDICARE PIN
ZZZP5701ZOtherCAMEDICAID/CHDP PIN
GNP000070MedicaidCA
GRW02104JMedicaidCA
CI4127OtherCARAILROAD MEDICARE PIN

Other names 1

  • Regents UCDPBG PED Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000892 CA Part B Supplier - Clinic/Group Practice 3375456619 Receives reassigned benefits from 2,647 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Locations

4501 X St
Sacramento, CA 95817
Phone (916) 734-5959

Practitioners & affiliated clinicians

Practitioners 49

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

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1104815067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10850 WHITE ROCK RD",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956706044",
            "telephone_number": "916-734-9200",
            "fax_number": "916-734-9661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2521 STOCKTON BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172207",
            "telephone_number": "916-734-3179",
            "fax_number": "916-456-2236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENTS OF THE UNIVERSITY OF CA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-13",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "TROVATTEN",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "VICE PRESIDENT, GOV'T REIMBURSEMENT",
        "authorized_official_telephone_number": "916-855-2315"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "CR0028",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID/CHDP PIN",
            "identifier": "ZZZP5701Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GNP000070",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GRW02104J",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "CI4127",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Regents UCDPBG PED",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Regents UCDPBG PED",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2025; 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.