Active NPI
Kimberly K Hissong, MD
- Anesthesiology Physician
- Sacramento, CA
National Provider Identifier
1194832006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- C139617
- Practice address
- 3315 Watt Ave
Sacramento, CA 95821-3600 - Phone
- (916) 481-6800
- Fax
- (916) 481-1881
- NPI assigned
- Aug 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 185262-1205 | UT | |
| Anesthesiology Physician | 207L00000X | C139617 | CA | Primary |
Addresses
Primary practice location
3315 Watt Ave
Sacramento, CA 95821-3600
Mailing address
3315 Watt Ave
Sacramento, CA 95821-3600
Phone (916) 481-6800
Other practice location 1
9300 Valley Childrens Pl
Madera, CA 93636-8761
Phone (559) 353-6115
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 107005891101 | Other | UT | IHC |
| 36403 | Other | UT | PEHP |
| 416939 | Other | UT | DESERET MUTUAL |
| 09300 | Other | CA | VALLEY CHILDRENS HEALTHCARE |
| PR00880 | Other | UT | MOLINA |
| 2403 | Other | UT | HEALTHY U |
| 002084559 | Other | UT | FIRST HEALTH |
| 870280408HI1 | Other | UT | EDUCATORS MUTUAL |
| 2000040 | Other | UT | UNITED HEALTHCARE |
| QM0000049524 | Other | UT | ALTIUS |
| 002966900 | Medicaid | ID | |
| 111000400 | Medicaid | WY | |
| 401765 | Medicaid | MT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C139617 | CA | MD | Anesthesiology Physician |
| 185262-1205 | UT | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sacsolano Anesthesia Exchange Medical Group, Inc | Anesthesiology | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Anesthesiology Physician
- Sacramento, CA
- NPI 1720401284
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599091200000",
"number": "1194832006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3315 WATT AVE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958213600",
"telephone_number": "916-481-6800",
"fax_number": "916-481-1881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3315 WATT AVE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958213600",
"telephone_number": "916-481-6800",
"fax_number": "916-481-1881"
}
],
"practiceLocations": [
{
"address_1": "9300 Valley Childrens Pl",
"address_purpose": "LOCATION",
"city": "Madera",
"state": "CA",
"postal_code": "936368761",
"country_code": "US",
"telephone_number": "559-353-6115",
"fax_number": "559-353-6123",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HISSONG",
"first_name": "KIMBERLY",
"middle_name": "K",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-24",
"last_updated": "2020-09-03",
"certification_date": "2020-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "UT",
"license": "185262-1205",
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "CA",
"license": "C139617",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IHC",
"identifier": "107005891101",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEHP",
"identifier": "36403",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DESERET MUTUAL",
"identifier": "416939",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALLEY CHILDRENS HEALTHCARE",
"identifier": "09300",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOLINA",
"identifier": "PR00880",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHY U",
"identifier": "2403",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "002084559",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EDUCATORS MUTUAL",
"identifier": "870280408HI1",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "2000040",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALTIUS",
"identifier": "QM0000049524",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002966900",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "111000400",
"state": "WY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "401765",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.