NPIMap

Organization Active NPI

Regents of the Univ of Ca

  • Pediatric Rheumatology Physician
  • Sacramento, CA
National Provider Identifier
1457344475
Registry record updated Mar 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Rheumatology PhysicianTaxonomy code 2080P0216X
Legal business name
REGENTS OF THE UNIV OF CA
Practice address
2521 Stockton Blvd
Sacramento, CA 95817-2207
Phone
(916) 734-3179
Fax
(916) 456-2236
NPI assigned
Aug 24, 2005
Last updated
Mar 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2014

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

Authorized official

Name
Mr. James D Kirk, MD
Title
Cmo
Phone
(916) 734-1166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Rheumatology Physician 2080P0216X NU Primary

Addresses

Primary practice location

2521 Stockton Blvd
Sacramento, CA 95817-2207

Mailing address

4900 Broadway
Ste 2600
Sacramento, CA 95820-1532
Phone (916) 734-9200

Other identifiers 9

IdentifierTypeStateIssuer
ZZZP5701ZOtherCAMEDICAID/CHDP PIN
CN4400OtherCARAILROAD MEDICARE PIN
CN4844OtherCARAILROAD MEDICARE PIN
CR0028OtherCARAILROAD MEDICARE PIN
DE7275OtherCARAILROAD MEDICARE PIN
GNP000070MedicaidCA
CI4127OtherCARAILROAD MEDICARE PIN
DA4168OtherCARAILROAD MEDICARE PIN
GRW021043MedicaidCA

Other names 1

  • Regents UCD PBG PED RHEUM Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000892 CA Part B Supplier - Clinic/Group Practice 3375456619 Receives reassigned benefits from 2,647 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Im General Medprof GP57 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395360000000",
    "number": "1457344475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 BROADWAY",
            "address_2": "STE 2600",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958201532",
            "telephone_number": "916-734-9200",
            "fax_number": "916-734-9661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2521 STOCKTON BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172207",
            "telephone_number": "916-734-3179",
            "fax_number": "916-456-2236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENTS OF THE UNIV OF CA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-24",
        "last_updated": "2014-03-21",
        "status": "A",
        "authorized_official_last_name": "KIRK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "916-734-1166",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080P0216X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Rheumatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID/CHDP PIN",
            "identifier": "ZZZP5701Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "CN4400",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "CN4844",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "CR0028",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "DE7275",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GNP000070",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "CI4127",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "DA4168",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GRW021043",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Regents UCD PBG PED RHEUM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2014; 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.