Sierra Orthopedic Laboratory, Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

SIERRA ORTHOPEDIC LABORATORY, INC.

Doing business as

Sierra Orthopedic Laboratory, Inc.

Practice address

157 Lynch Creek Way
Petaluma, CA 94954-2342

Phone

(707) 528-9808

Fax

(707) 528-9818

NPI assigned

May 4, 2020

Last updated

Nov 18, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

SIERRA ORTHOPEDIC LABORATORY, INC.As reported in NPPES

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

Authorized official

Name

David John Jeffries, C.O.NPI 1962714865

Title

Owner

Phone

(707) 528-9808

Specialties & licenses 1

Addresses

Other names 1

• Sierra Orthopedic Laboratory, Inc. Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Sierra Orthopedic Laboratory, Inc.

  • Prosthetic/Orthotic Supplier
  • Santa Rosa, CA
  • NPI 1659366003

  0749307601

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Sierra Orthopedics Lab3 organizations share this tax ID, including this one

Part of

Sierra Orthopedics Lab

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Sierra Orthopedic Lab

  • Prosthetic/Orthotic Supplier
  • Oakdale, CA
  • NPI 1225253578
  NPD tax ID
• Sierra Orthopedic Laboratory, Inc.

  • Prosthetic/Orthotic Supplier
  • Santa Rosa, CA
  • NPI 1659366003
  NPD tax ID

Locations

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.

• David John Jeffries, C.O.

  • Orthotist
  • Santa Rosa, CA
  • NPI 1962714865
  NPD (past) Authorized official

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

{
    "created_epoch": "1588550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637193600000",
    "number": "1417578121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1848",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949481848",
            "telephone_number": "707-528-9808",
            "fax_number": "707-528-9818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 LYNCH CREEK WAY",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949542342",
            "telephone_number": "707-528-9808",
            "fax_number": "707-528-9818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIERRA ORTHOPEDIC LABORATORY, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SIERRA ORTHOPEDIC LABORATORY, INC.",
        "enumeration_date": "2020-05-04",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A",
        "authorized_official_last_name": "JEFFRIES",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-528-9808",
        "authorized_official_credential": "C.O."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sierra Orthopedic Laboratory, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sierra Orthopedic Laboratory, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Shouse, LAC
• Diane Elizabeth Shrock, LMFT
• Julie L. Shulman, PH.D.
• Brian Kent Sibbald, D.D.S.
• Kayla Sibbaluca, ATC
• Yesenia Sierra I
• Jasmine Marie Sigmann
• Mallissa Lynettee Silva
• Jill Ann Silverman, M.F.T.
• Lovell Sims

• Prosthetic/Orthotic Supplier in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Prosthetic/Orthotic Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.