Individual provider Active NPI

Myron Jimenez, O.D.

  • Optometrist
  • Folsom, CA
National Provider Identifier
1174076681
Registry record updated Aug 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
33463 Issued in CA
Practice address
1730 Prairie City Rd Ste 120
Folsom, CA 95630-9594
Phone
(916) 351-4800
Fax
(916) 351-4899
NPI assigned
Aug 2, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 33463 CA Primary

Addresses

Primary practice location

1730 Prairie City Rd Ste 120
Folsom, CA 95630-9594

Mailing address

3400 Data Dr
Rancho Cordova, CA 95670-7956

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170301001957 TX Practitioner - Optometry 1658655188 Reassigns benefits to 1 organization
I20171011002678 CA Practitioner - Optometry 1658655188 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dignity Health Medical FoundationGroup PAC ID 7810800661, 1,211 clinicians

Practice addresses (Care Compare)

1730 Prairie City Rd
Suite 120
Folsom, CA 95630-9594
Phone (916) 351-4800

Merit-based Incentive Payment System (MIPS)

Final score
99.64 of 100Reported as apm
Quality
86.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health Medical Foundation CurrentSince Sep 5, 2017 Accepting new patients
Santa Fe Indian Hospital CurrentSince Jan 21, 2017 Accepting new patients
Dignity Health Medical Foundation CurrentSince Sep 5, 2017 Accepting new patients
Dignity Health Medical Foundation Past Accepting new patients

Locations

3400 Data Dr
Rncho Cordova, CA 95670
Phone (916) 379-2726

3000 Q St
Sacramento, CA 95816
Phone (916) 733-5701

400 State Road 30
Espanola, NM 87532
Phone (505) 753-8393

1700 Cerrillos Rd
Santa Fe, NM 87505
Phone (505) 946-9206

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1470096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504051200000",
    "number": "1174076681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 PRAIRIE CITY RD STE 120",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956309594",
            "telephone_number": "916-351-4800",
            "fax_number": "916-351-4899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "MYRON",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-02",
        "last_updated": "2017-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "33463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Folsom, CA

Sources for this page

Verify at the official NPI Registry.