NPIMap

Individual provider Active NPI

Gregory Daniel Spin, D.O.

  • Nephrology Physician
  • Roseville, CA
National Provider Identifier
1114977386
Registry record updated Dec 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
20A7602 Issued in CA
Practice address
151 N Sunrise Ave
Suite 1205
Roseville, CA 95661-2924
Phone
(916) 789-1505
Fax
(916) 789-1513
NPI assigned
May 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 20A7602 CA Primary

Addresses

Primary practice location

151 N Sunrise Ave
Suite 1205
Roseville, CA 95661-2924

Mailing address

151 N Sunrise Ave
Suite 1205
Roseville, CA 95661-2924
Phone (916) 789-1505

Other identifiers 2

IdentifierTypeStateIssuer
20A7602OtherCAOSTEOPATH MEDICAL LICENSE
GR0100970MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050211000904 CA Practitioner - NephrologyPractitioner - Internal Medicine 7911959408 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
College of Osteopathic Physicians and Surgeons of Los Angeles, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Nephrology Medical Group, Inc.Group PAC ID 9638107733, 10 clinicians

Practice addresses (Care Compare)

151 N Sunrise Ave
Suite 1202
Roseville, CA 95661-2932
Phone (916) 789-1505

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7602CAMDContractor
20A7602CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Nephrology Medical Group, Inc Nephrology CurrentSince Jul 1, 2005 Accepting new patients
Dva Renal Healthcare Inc PastSince Nov 1, 2021 Accepting new patients
Sierra Nevada Memorial-Miners Hospital Past Accepting new patients
Hill Physicians Medical Group - PPO Program Past Accepting new patients
Sutter Coast Hospital Past Accepting new patients
Sutter Regional Medical Foundation Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients

Locations

11969 Heritage Oak Pl
Auburn, CA 95603
Phone (530) 878-5950

151 N Sunrise Ave
Ste 1202
Roseville, CA 95661
Phone (916) 789-1505

151 N Sunrise Ave
Ste 1205
Roseville, CA 95661
Phone (916) 780-0110

Interoperability endpoints

  • Direct secure messaging: gspin15212@hisp.ehr.sutterhealth.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418601600000",
    "number": "1114977386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 N SUNRISE AVE",
            "address_2": "SUITE 1205",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956612924",
            "telephone_number": "916-789-1505",
            "fax_number": "916-789-1513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 N SUNRISE AVE",
            "address_2": "SUITE 1205",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956612924",
            "telephone_number": "916-789-1505",
            "fax_number": "916-789-1513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPIN",
        "first_name": "GREGORY",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2014-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "20A7602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OSTEOPATH MEDICAL LICENSE",
            "identifier": "20A7602",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0100970",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

Verify at the official NPI Registry.