NPIMap

Organization Active NPI

West Sacramentopediatric Medical Group,Inc

  • Clinic/Center
  • West Sacramento, CA
National Provider Identifier
1215009212
Registry record updated Sep 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
208000000X Issued in CA
Legal business name
WEST SACRAMENTOPEDIATRIC MEDICAL GROUP,INC
Practice address
1050 Jefferson Blvd
West Sacramento, CA 95691-3304
Phone
(916) 371-3787
Fax
(916) 371-3790
NPI assigned
Nov 14, 2006
Last updated
Sep 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2008

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

Authorized official

Name
Ms. Judith J Tarrant, RN,FNPNPI 1619052511
Title
Provider, Co-Owner
Phone
(916) 371-3787

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 208000000X CA Primary

Addresses

Primary practice location

1050 Jefferson Blvd
West Sacramento, CA 95691-3304

Mailing address

1050 Jefferson Blvd
West Sacramento, CA 95691-3304
Phone (916) 371-3787

Other identifiers 2

IdentifierTypeStateIssuer
1841836OtherCAPIN
GR0101570OtherCAGROUP NUMBER FOR CHDP

National Provider Directory

National Provider Directory

Locations

1050 Jefferson Blvd
West Sacramento, CA 95691
Phone (916) 371-3787

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221609600000",
    "number": "1215009212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 JEFFERSON BLVD",
            "city": "WEST SACRAMENTO",
            "state": "CA",
            "postal_code": "956913304",
            "telephone_number": "916-371-3787",
            "fax_number": "916-371-3790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 JEFFERSON BLVD",
            "city": "WEST SACRAMENTO",
            "state": "CA",
            "postal_code": "956913304",
            "telephone_number": "916-371-3787",
            "fax_number": "916-371-3790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST SACRAMENTOPEDIATRIC MEDICAL GROUP,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2008-09-17",
        "status": "A",
        "authorized_official_last_name": "TARRANT",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PROVIDER, CO-OWNER",
        "authorized_official_telephone_number": "916-371-3787",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN,FNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "208000000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PIN",
            "identifier": "1841836",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NUMBER FOR CHDP",
            "identifier": "GR0101570",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.