Elaine Therese Van Gundy, M.D., F.A.A.P.

Primary specialty

SpecialistTaxonomy code 174400000X

License

C43153 Issued in CA

Practice address

1451 Secret Ravine Pkwy
Suite 150
Roseville, CA 95661-4051

Phone

(916) 580-2420

Fax

(916) 580-2402

NPI assigned

Jun 12, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: evangundymd58618@hisp.ehr.sutterhealth.org

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.

• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1669846986

  CA

  Medicare reassignment NPD
• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Fairfield, CA
  • NPI 1184859894
  NPD
• Sutter Valley Medical Foundation

  • Durable Medical Equipment & Medical Supplies
  • Tracy, CA
  • NPI 1720930712
  NPD
• Perinatal & Pediatric Specialists Medical Group Inc.

  • Specialist
  • Sacramento, CA
  • NPI 1114007432
  NPD (past)
• Sutter Valley Medical Foundation

  • Durable Medical Equipment & Medical Supplies
  • Sacramento, CA
  • NPI 1295800787
  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1174565485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1451 SECRET RAVINE PKWY",
            "address_2": "SUITE 150",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614051",
            "telephone_number": "916-580-2420",
            "fax_number": "916-580-2402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 SECRET RAVINE PKWY",
            "address_2": "SUITE 150",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614051",
            "telephone_number": "916-580-2420",
            "fax_number": "916-580-2402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN GUNDY",
        "first_name": "ELAINE",
        "middle_name": "THERESE",
        "credential": "M.D., F.A.A.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "C43153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C431530",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valley Hyperbaric Center Inc
• Dana Van Aelstyn, LCSW
• Holly Van Brocklin
• Jessica Van Der Haegen, BS
• Neil Alan Van Dyck, DPM
• Heather D Van Horn, PTA
• Michelle Van Ness, MFT
• Kate M Van Parys, MFT
• Becky Van Velzer, L.C.S.W.
• Angeles Van Vleet, MS SLP

• All providers in Roseville, CA
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.