Siskiyou Eye Center, Medical Group, Inc

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

FNP26049 Issued in CA

Legal business name

SISKIYOU EYE CENTER, MEDICAL GROUP, INC

Doing business as

Siskiyou Eye Center

Practice address

2524 Westside Rd
Yreka, CA 96097-9129

Phone

(530) 842-2760

Fax

(530) 842-5839

NPI assigned

Jun 13, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Belmira Pardal Borg

Title

Administrator

Phone

(530) 842-2760

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Siskiyou Eye Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA, OR2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 6

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

• Amy J Walport, O.D.

  • Optometrist
  • Mira Loma, CA
  • NPI 1831408186
  Medicare reassignment Care Compare group NPD
• David Steven England, OD

  • Optometrist
  • Ashland, OR
  • NPI 1942205448

  CA

  Medicare reassignment Care Compare group NPD
• William Stuart Epstein, MD

  • Ophthalmology Physician
  • Ashland, OR
  • NPI 1740285667

  CA

  Medicare reassignment Care Compare group NPD
• Robert Henry Ewing Jr., MD

  • Ophthalmology Physician
  • Ashland, OR
  • NPI 1548265267

  CA

  Medicare reassignment Care Compare group NPD
• Jared Scott Fredrickson, MD

  • Ophthalmology Physician
  • Ashland, OR
  • NPI 1902394893

  CA

  Medicare reassignment Care Compare group NPD
• Jeffrey David Welder, M.D.

  • Ophthalmology Physician
  • Ashland, OR
  • NPI 1043504681

  CA

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268265600000",
    "number": "1144224577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2524 WESTSIDE RD",
            "city": "YREKA",
            "state": "CA",
            "postal_code": "960979129",
            "telephone_number": "530-842-2760",
            "fax_number": "530-842-5839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2524 WESTSIDE RD",
            "city": "YREKA",
            "state": "CA",
            "postal_code": "960979129",
            "telephone_number": "530-842-2760",
            "fax_number": "530-842-5839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SISKIYOU EYE CENTER, MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-13",
        "last_updated": "2010-03-11",
        "status": "A",
        "authorized_official_last_name": "BORG",
        "authorized_official_first_name": "BELMIRA",
        "authorized_official_middle_name": "PARDAL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "530-842-2760",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "FNP26049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BXBS OF CA",
            "identifier": "ZZZ550452",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Siskiyou Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nancy Sesson, RN
• Amy Seyms, MS OTRL
• Sharon Barbara Shepard, MFT
• Siskiyou Chiropractic & Massage
• Siskiyou County Public Health Department
• Siskiyou Family Healthcare, Inc. (Siskiyou Family Healthcare)
• Siskiyou Home Health Services
• Siskiyou Hospital Inc (Fairchild Dental Clinic)
• Siskiyou Hospital Inc. (Siskiyou Family Healthcare)
• Siskiyou Hospital, Inc. (Fairchild Medical Center)

• Ophthalmology Physician in Yreka, CA
• Providers in Yreka, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.