NPIMap

Organization Active NPI

Sierra Orthopedic Institute Medical Corporation

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Sonora, CA
National Provider Identifier
1487967303
Registry record updated Jan 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
20A10879 Issued in CA
Legal business name
SIERRA ORTHOPEDIC INSTITUTE MEDICAL CORPORATION
Practice address
13949 Mono Way
Sonora, CA 95370-2807
Phone
(209) 533-5371
NPI assigned
Jul 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2020

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

Authorized official

Name
Ariana Marie Demers, DONPI 1477676047
Title
Physician/Owner
Phone
(209) 533-5371

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
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XX0005X 20A10879 CA Primary

Addresses

Primary practice location

13949 Mono Way
Sonora, CA 95370-2807

Mailing address

13949 Mono Way
Sonora, CA 95370-2807
Phone (209) 629-0077

Other names 1

  • Restore Orthopedic & Sports Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101108001341 CA Part B Supplier - Clinic/Group Practice 2163617804 Receives reassigned benefits from 4 practitioners
Practice locations: Sonora, CA

National Provider Directory

National Provider Directory
Tax ID family
Sierra Orthopedic Institute2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

13949 Mono Way
Sonora, CA 95370
Phone (209) 213-9184

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

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": "1279584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580342400000",
    "number": "1487967303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13949 MONO WAY",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953702807",
            "telephone_number": "209-629-0077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13949 MONO WAY",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953702807",
            "telephone_number": "209-533-5371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIERRA ORTHOPEDIC INSTITUTE MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-20",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A",
        "authorized_official_last_name": "DEMERS",
        "authorized_official_first_name": "ARIANA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "209-533-5371",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "20A10879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Restore Orthopedic & Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sonora, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2020; 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.