Active NPI
Audrey Y. Pan, D.O.
- Family Medicine Physician
- Sacramento, CA
National Provider Identifier
1215946496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 20A8667
- Practice address
- 3160 Folsom Blvd
Sacramento, CA 95816-5219 - Phone
- (916) 733-5336
- Fax
- (916) 733-5385
- NPI assigned
- Aug 5, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 20A8667 | CA | Primary |
Addresses
Primary practice location
3160 Folsom Blvd
Sacramento, CA 95816-5219
Mailing address
3160 Folsom Blvd
Sacramento, CA 95816-5219
Phone (916) 733-3440
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00AX86670 | Medicaid | CA | |
| 000810568272 | Other | CA | PHCS |
| 102632 | Other | CA | HEALTH NET |
| 2358909 | Other | CA | UNITED HEALTHCARE |
| 90136584 | Other | CA | PACIFICARE |
| 20A8667 | Other | CA | BLUE CROSS |
| 2149412 | Other | CA | FIRST HEALTH |
| 7810479 | Other | CA | AETNA |
| 5013958 | Other | CA | CIGNA |
| 1708821 | Other | CA | GREAT WEST |
| 99081 | Other | CA | INTERPLAN |
| MCMG274500 | Other | CA | WESTERN HEALTH ADVANTAGE |
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 Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190592000000",
"number": "1215946496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3160 FOLSOM BLVD",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958165219",
"telephone_number": "916-733-3440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3160 FOLSOM BLVD",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958165219",
"telephone_number": "916-733-5336",
"fax_number": "916-733-5385"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAN",
"first_name": "AUDREY",
"middle_name": "Y.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-05",
"last_updated": "2007-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "20A8667",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00AX86670",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS",
"identifier": "000810568272",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NET",
"identifier": "102632",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "2358909",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PACIFICARE",
"identifier": "90136584",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "20A8667",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "2149412",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7810479",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "5013958",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREAT WEST",
"identifier": "1708821",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INTERPLAN",
"identifier": "99081",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WESTERN HEALTH ADVANTAGE",
"identifier": "MCMG274500",
"state": "CA"
}
],
"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 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.