NPIMap

Organization Active NPI

Lively Virtual Care Organization PC

  • Point of Service
  • Roseville, CA
National Provider Identifier
1447938683
Registry record updated Feb 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Point of ServiceTaxonomy code 305S00000X
Legal business name
LIVELY VIRTUAL CARE ORGANIZATION PC
Doing business as
Lively Virtual Care Organization PC
Practice address
108 Ben Ezra Ave
Roseville, CA 95678-2702
Phone
(916) 235-8617
Fax
(916) 846-9463
NPI assigned
Jul 7, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2024

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

Authorized official

Name
Sandra Kocsis, MHANPI 1073166831
Title
Ceo
Phone
(916) 622-3609

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 7

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Home Health Agency 251E00000X
Early Intervention Provider Agency 252Y00000X
In Home Supportive Care Agency 253Z00000X
Clinic/Center 261Q00000X
Point of Service 305S00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

108 Ben Ezra Ave
Roseville, CA 95678-2702

Mailing address

PO Box 604
Roseville, CA 95661-0604
Phone (916) 622-3609

Other practice location 1

108 Ben Ezra Ave
Roseville, CA 95678-2702
Phone (916) 622-3609

Other names 1

  • Lively Virtual Care Organization PC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231115003359 CA Part B Supplier - Clinic/Group Practice 7911354766 Receives reassigned benefits from 3 practitioners
Practice locations: Roseville, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1688688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707091200000",
    "number": "1447938683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 604",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956610604",
            "telephone_number": "916-622-3609",
            "fax_number": "916-333-3634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 BEN EZRA AVE",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956782702",
            "telephone_number": "916-235-8617",
            "fax_number": "916-846-9463"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "108 Ben Ezra Ave",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "CA",
            "postal_code": "956782702",
            "country_code": "US",
            "telephone_number": "916-622-3609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIVELY VIRTUAL CARE ORGANIZATION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-07",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A",
        "authorized_official_last_name": "KOCSIS",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-622-3609",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lively Virtual Care Organization PC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lively Virtual Care Organization PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; 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.