Individual provider Active NPI

Melissa Bersamina, O.D.

  • Optometrist
  • San Diego, CA
National Provider Identifier
1205085925
Registry record updated Dec 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT 13490 TPA Issued in CA
Practice address
34800 Bob Wilson Dr
Nmcsd
San Diego, CA 92134-1098
Phone
(619) 532-8225
NPI assigned
Sep 18, 2008
Last updated
Dec 2, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT 13490 TPA CA Primary

Addresses

Primary practice location

34800 Bob Wilson Dr
Nmcsd
San Diego, CA 92134-1098

Mailing address

34800 Bob Wilson Dr
Nmcsd
San Diego, CA 92134-1098
Phone (619) 532-8225

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121102000286 CA Practitioner - Optometry 9638320435 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4647 Zion Ave
San Diego, CA 92120-2507
Phone (619) 528-5000

6911 Convoy CT
San Diego, CA 92111-1014
Phone (858) 573-1504

8080 Pkwy Dr
La Mesa, CA 91942-2104
Phone (619) 528-5000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT 13490 TPACAMDOptometrist
13490CAMDPhysical Therapy Clinic/Center

Practice roles

OrganizationSpecialtyStatusNew patients
Third Optometric Care of California Optometrist Current Accepting new patients
Third Optometric Care of California PC Optometrist CurrentSince Aug 1, 2024 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 22, 2013 Accepting new patients
Eye Center Optometrics, a Professional Corporation Optometrist Current Accepting new patients
Eye Center Optometrics, a Professional Corporation Optometrist CurrentSince Aug 12, 2024 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 22, 2013 Accepting new patients
Eye Center Optometrics, a Professional Corporation Optometrist CurrentSince Aug 12, 2024 Accepting new patients
Third Optometric Care of California Optometrist CurrentSince Aug 1, 2024 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

5959 Greenback Ln
Ste 130
Citrus Hts, CA 95621
Phone (916) 726-1818

393 E Walnut St
Pasadena, CA 91188
Phone (626) 405-7914

1850 N Riverside Ave
Ste 220
Rialto, CA 92376
Phone (909) 421-3003

3333 Quality Dr
Rncho Cordova, CA 95670
Phone (704) 712-0564

6809 Five Star Blvd
Ste 100A
Rocklin, CA 95677
Phone (916) 624-2020

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

Organizations & group practices 9

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

NPI Registry JSON

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

{
    "created_epoch": "1221696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638403200000",
    "number": "1205085925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34800 BOB WILSON DR",
            "address_2": "NMCSD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921341098",
            "telephone_number": "619-532-8225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34800 BOB WILSON DR",
            "address_2": "NMCSD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921341098",
            "telephone_number": "619-532-8225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERSAMINA",
        "first_name": "MELISSA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-18",
        "last_updated": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 13490 TPA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.