NPIMap

Organization Active NPI

Land Park Pediatric Medical Group

  • Pediatrics Physician
  • Sacramento, CA
National Provider Identifier
1487018990
Registry record updated Apr 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A56390 Issued in CA
Legal business name
LAND PARK PEDIATRIC MEDICAL GROUP
Practice address
4617 Freeport Blvd Ste B
Sacramento, CA 95822-2015
Phone
(916) 422-7273
Fax
(916) 422-2127
NPI assigned
Apr 11, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2016

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

Authorized official

Name
Ravinder Singh Khaira, M.D.NPI 1902842354
Title
Physician/Owner
Phone
(916) 422-7273

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X A56390 CA Primary

Addresses

Primary practice location

4617 Freeport Blvd Ste B
Sacramento, CA 95822-2015

Mailing address

4617 Freeport Blvd Ste B
Sacramento, CA 95822-2015
Phone (916) 422-7273

National Provider Directory

National Provider Directory
Tax ID family
Land Park Pediatric Medical Group3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

5841 Jameson Ct
Ste 1
Carmichael, CA 95608
Phone (916) 485-9800

1355 Florin Rd
Ste 10
Sacramento, CA 95822
Phone (916) 422-7273

1050 Jefferson Blvd
West Sacramento, CA 95691
Phone (916) 371-3787

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 1

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": "1460332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460332800000",
    "number": "1487018990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4617 FREEPORT BLVD STE B",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958222015",
            "telephone_number": "916-422-7273",
            "fax_number": "916-422-2127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4617 FREEPORT BLVD STE B",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958222015",
            "telephone_number": "916-422-7273",
            "fax_number": "916-422-2127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAND PARK PEDIATRIC MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-11",
        "last_updated": "2016-04-11",
        "status": "A",
        "authorized_official_last_name": "KHAIRA",
        "authorized_official_first_name": "RAVINDER",
        "authorized_official_middle_name": "SINGH",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "916-422-7273",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A56390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.