NPIMap

Organization Active NPI

Bruce V Lattyak M.D., Inc.

  • Plastic Surgery Physician
  • Grass Valley, CA
National Provider Identifier
1275707424
Registry record updated Aug 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
A62583 Issued in CA
Legal business name
BRUCE V LATTYAK M.D., INC.
Practice address
300 Sierra College Dr Ste 240
Grass Valley, CA 95945-5086
Phone
(530) 273-3400
Fax
(530) 274-3400
NPI assigned
Apr 18, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2019

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

Authorized official

Name
Bruce V Lattyak, MDNPI 1629245238
Title
Owner
Phone
(530) 477-1199

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X A62583 CA
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208200000X A62583 CA Primary

Addresses

Primary practice location

300 Sierra College Dr Ste 240
Grass Valley, CA 95945-5086

Mailing address

300 Sierra College Dr Ste 240
Grass Valley, CA 95945-5086
Phone (530) 273-3400

Other practice location 1

280 Sierra College Drive
Suite 105
Grass Valley, CA 95945
Phone (530) 273-3400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090105000284 CA Part B Supplier - Clinic/Group Practice 2466514245 Receives reassigned benefits from 2 practitioners
Practice locations: Grass Valley, CA

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AFDHCA

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567036800000",
    "number": "1275707424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SIERRA COLLEGE DR STE 240",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959455086",
            "telephone_number": "530-273-3400",
            "fax_number": "530-274-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 SIERRA COLLEGE DR STE 240",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959455086",
            "telephone_number": "530-273-3400",
            "fax_number": "530-274-3400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "280 Sierra College Drive",
            "address_2": "Suite 105",
            "address_purpose": "LOCATION",
            "city": "Grass Valley",
            "state": "CA",
            "postal_code": "95945",
            "country_code": "US",
            "telephone_number": "530-273-3400",
            "fax_number": "530-274-3400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRUCE V LATTYAK M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-18",
        "last_updated": "2019-08-29",
        "status": "A",
        "authorized_official_last_name": "LATTYAK",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "530-477-1199",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A62583",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "A62583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grass Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.