NPIMap

Organization Active NPI

Spine & Nerve Diagnostic Center

  • Physical Medicine & Rehabilitation Physician
  • Roseville, CA
National Provider Identifier
1144628504
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
00A63460 Issued in CA
Legal business name
SPINE & NERVE DIAGNOSTIC CENTER
Practice address
1528 Eureka Rd Ste 103
Roseville, CA 95661-3047
Phone
(916) 772-5325
Fax
(916) 772-6333
NPI assigned
Dec 16, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Vinay Moola Reddy, M.D.NPI 1548203961
Title
MD/President
Phone
(916) 772-5325

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Electrodiagnostic Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 204R00000X 00A63460 CA
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X 00A63460 CA Primary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X 00A83749 CA
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X 00A83749 CA
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X 00A63460 CA

Addresses

Primary practice location

1528 Eureka Rd Ste 103
Roseville, CA 95661-3047

Mailing address

1528 Eureka Rd Ste 103
Roseville, CA 95661-3047
Phone (916) 772-5325

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150319001739 CA Part B Supplier - Clinic/Group Practice 9830416460 Receives reassigned benefits from 55 practitioners
2 other NPIs on this enrollment
Practice locations: Granite Bay, CA; Sacramento, CA; Roseville, CA; Lincoln, CA; Elk Grove, CA; Folsom, CA; Davis, CA
O20160114002691 CA DME Supplier - Multi-Specialty - Physician 9830416460 Practice locations: Roseville, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1097143Spine and Nerve Diagnostic Center1528 Eureka Rd Ste 103, Roseville, CA 95661AccreditationJun 18, 2027

National Provider Directory

National Provider Directory

Locations

2234 Longport Ct
Ste 1
Elk Grove, CA 95758

1528 Eureka Rd
Ste 103
Roseville, CA 95661
Phone (916) 772-5325

Practitioners & affiliated clinicians

Practitioners 55

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

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1418688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1144628504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1528 EUREKA RD STE 103",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613047",
            "telephone_number": "916-772-5325",
            "fax_number": "916-772-6333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1528 EUREKA RD STE 103",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613047",
            "telephone_number": "916-772-5325",
            "fax_number": "916-772-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE & NERVE DIAGNOSTIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-16",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "REDDY",
        "authorized_official_first_name": "VINAY",
        "authorized_official_middle_name": "MOOLA",
        "authorized_official_title_or_position": "MD/PRESIDENT",
        "authorized_official_telephone_number": "916-772-5325",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "204R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Electrodiagnostic Medicine",
            "state": "CA",
            "license": "00A63460",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "00A63460",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "00A83749",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "CA",
            "license": "00A83749",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "CA",
            "license": "00A63460",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.