NPIMap

Organization Active NPI

Eye Associates of Sebastopol Medical Group Inc

  • Ophthalmology Physician
  • Sebastopol, CA
National Provider Identifier
1295729382
Registry record updated Sep 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
EYE ASSOCIATES OF SEBASTOPOL MEDICAL GROUP INC
Practice address
6880 Palm Ave
Sebastopol, CA 95472-4270
Phone
(707) 823-7628
Fax
(707) 823-1521
NPI assigned
Sep 6, 2005
Last updated
Sep 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2020

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

Authorized official

Name
Ms. Kim Khamthee
Title
Billing Manager
Phone
(707) 823-0229

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

6880 Palm Ave
Sebastopol, CA 95472-4270

Mailing address

6880 Palm Ave
Sebastopol, CA 95472-4270
Phone (707) 823-7628

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050201000776 CA Part B Supplier - Clinic/Group Practice 1052362696 Receives reassigned benefits from 13 practitioners
Practice locations: Clearlake, CA; Sebastopol, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

4456 Manzanita Ave
#2
Clearlake, CA 95422
Phone (707) 461-5027

6574 Oakmont Dr
Santa Rosa, CA 95409
Phone (707) 331-7148

85 Brookwood Ave
Ste 12
Santa Rosa, CA 95404
Phone (312) 320-0090

181 Andrieux St
Ste 105
Sonoma, CA 95476
Phone (707) 938-2020

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598918400000",
    "number": "1295729382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6880 PALM AVE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724270",
            "telephone_number": "707-823-7628",
            "fax_number": "707-823-1521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6880 PALM AVE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724270",
            "telephone_number": "707-823-7628",
            "fax_number": "707-823-1521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE ASSOCIATES OF SEBASTOPOL MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-06",
        "last_updated": "2020-09-01",
        "certification_date": "2020-08-21",
        "status": "A",
        "authorized_official_last_name": "KHAMTHEE",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "707-823-0229",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sebastopol, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; 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.