Individual provider Active NPI

John Michael Schaeffer, DDS

  • General Practice Dentistry
  • Sacramento, CA
National Provider Identifier
1417679747
Registry record updated Sep 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
108041 Issued in CA
Practice address
4190 Truxel Rd
Sacramento, CA 95834-3757
Phone
(916) 928-9999
NPI assigned
Sep 13, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 108041 CA Primary

Addresses

Primary practice location

4190 Truxel Rd
Sacramento, CA 95834-3757

Mailing address

4832 10TH Ave
Sacramento, CA 95820-2206
Phone (515) 401-2195

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250808003949 CA Order and Referring Only - DentistPractitioner - Dentist 8628576642

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
108041CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Sheila N Harris, DDS Inc General Practice PastSince Sep 20, 2022 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1663027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1417679747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4832 10TH AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958202206",
            "telephone_number": "515-401-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 TRUXEL RD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958343757",
            "telephone_number": "916-928-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHAEFFER",
        "first_name": "JOHN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-13",
        "last_updated": "2022-09-13",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "108041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.