Individual provider Active NPI

Robert Grinnell Trent, MD

  • Ophthalmology Physician
  • Redding, CA
National Provider Identifier
1114913761
Registry record updated Oct 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
G86708 Issued in CA
Practice address
3190 Churn Creek Rd
Redding, CA 96002-2122
Phone
(530) 223-2500
Fax
(530) 226-1375
NPI assigned
Sep 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X G86708 CA Primary

Addresses

Primary practice location

3190 Churn Creek Rd
Redding, CA 96002-2122

Mailing address

3190 Churn Creek Rd
Redding, CA 96002-2122
Phone (530) 223-2500

Other identifiers 1

IdentifierTypeStateIssuer
00G867080MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14182SCMDPharmacist
G86708CAMDOphthalmology Physician

NPI Registry JSON

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351123200000",
    "number": "1114913761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3190 CHURN CREEK RD",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960022122",
            "telephone_number": "530-223-2500",
            "fax_number": "530-226-1375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3190 CHURN CREEK RD",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960022122",
            "telephone_number": "530-223-2500",
            "fax_number": "530-226-1375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRENT",
        "first_name": "ROBERT",
        "middle_name": "GRINNELL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2012-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G86708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G867080",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Redding, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; 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.