Active NPI
Boungkhong David Vansomphone, M.D.
- Internal Medicine Physician
- Las Vegas, NV
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 9448
- Practice address
- 5375 S Fort Apache Rd
Ste# 101
Las Vegas, NV 89148-7623 - Phone
- (702) 597-1597
- NPI assigned
- Sep 22, 2006
- Last updated
- Dec 23, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 9448 | NV | Primary |
Addresses
Primary practice location
5375 S Fort Apache Rd
Ste# 101
Las Vegas, NV 89148-7623
Mailing address
PO Box 35984
Las Vegas, NV 89133-5984
Phone (702) 453-3799
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002018399 | Medicaid | NV | |
| 12431 | Other | MT | LIC |
| C53921 | Other | CA | LIC |
| DR48601 | Other | CO | LIC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV, CA, WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 3
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- University of Nevada School of Medicine, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1016 Tacoma Ave
Sunnyside, WA 98944-2263
Phone (509) 837-1500
118 E Haskell St
Winnemucca, NV 89445-3247
Phone (775) 623-5222
1375 University St
Healdsburg, CA 95448-3382
Phone (707) 431-6500
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Monterey County Memorial Hospital | Current | Accepting new patients | |
| Southern Monterey County Memorial Hospital | Current | Accepting new patients | |
| Sunnyside Community Hospital Association | Past | Accepting new patients |
Locations
210 Canal St
King City, CA 93930
Phone (931) 385-7100
300 Canal St
King City, CA 93930
Phone (831) 385-6000
400 Canal St
Ste B
King City, CA 93930
Phone (831) 385-1280
Interoperability endpoints
- dvansomp@yourcarecommunity.org
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Mee Memorial Healthcare System
- Critical Access Hospital
- King City, CA
- NPI 1114917564
-
dba Family Medical Center
- Clinic/Center
- King City, CA
- NPI 1821300427
-
dba Astria Sunnyside Hospital
- Critical Access Hospital
- Sunnyside, WA
- NPI 1225033814
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Asante Rogue Regional Medical Center
- General Acute Care Hospital
- Medford, OR
- NPI 1770587107
-
dba Astria Toppenish Hospital
- General Acute Care Hospital
- Toppenish, WA
- NPI 1851817308
-
dba Fairchild Medical Center
- Critical Access Hospital
- Yreka, CA
- NPI 1093892275
-
dba Fairchild Medical Center
- Critical Access Hospital
- Yreka, CA
- NPI 1952701369
-
dba Astria Sunnyside Hospital
- Critical Access Hospital
- Sunnyside, WA
- NPI 1225033814
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1293062400000",
"number": "1457451262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 35984",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891335984",
"telephone_number": "702-453-3799",
"fax_number": "702-453-5741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5375 S FORT APACHE RD",
"address_2": "STE# 101",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891487623",
"telephone_number": "702-597-1597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANSOMPHONE",
"first_name": "BOUNGKHONG",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-22",
"last_updated": "2010-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NV",
"license": "9448",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002018399",
"state": "NV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LIC",
"identifier": "12431",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LIC",
"identifier": "C53921",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LIC",
"identifier": "DR48601",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.