Sacramento Ear Nose & Throat Surgical & Medical Group Inc

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

SACRAMENTO EAR NOSE & THROAT SURGICAL & MEDICAL GROUP INC

Practice address

1111 Exposition Blvd BLDG 700
Sacramento, CA 95815-4314

Phone

(916) 736-3399

Fax

(916) 736-3350

NPI assigned

May 24, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Nina Li

Title

Cfo

Phone

(916) 736-3399

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Sacramento Ear, Nose, & Throat Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Simone Alexandra Barker, MD

  • Otolaryngology Physician
  • Folsom, CA
  • NPI 1972063378
  Medicare reassignment Care Compare group NPD
• Kristin Michelle Bennett, M.D.

  • Otolaryngology Physician
  • Stockton, CA
  • NPI 1922047299
  Medicare reassignment Care Compare group NPD
• Brent Jason Benscoter, MD

  • Otology & Neurotology Physician
  • Sacramento, CA
  • NPI 1376703454

  Otolaryngology

  Medicare reassignment Care Compare group NPD
• Matthew Stiles Bowdish, M.D.

  • Allergy & Immunology Physician
  • Roseville, CA
  • NPI 1770767923
  Medicare reassignment Care Compare group NPD
• Daniel Abraham Carlton, M.D.

  • Otolaryngology Physician
  • Roseville, CA
  • NPI 1760725683
  Medicare reassignment Care Compare group NPD
• Donald J Clutter, MD

  • Otolaryngology/Facial Plastic Surgery Physician
  • Folsom, CA
  • NPI 1598768277
  Medicare reassignment Care Compare group NPD
• Susan R Cordes, M.D.

  • Otolaryngology Physician
  • Stockton, CA
  • NPI 1285668707
  Medicare reassignment Care Compare group NPD
• Dylan John Dekalb, PAC

  • Physician Assistant
  • Sacramento, CA
  • NPI 1477347466
  Medicare reassignment Care Compare group NPD
• Ronald George Dong, M.D.

  • Otolaryngology Physician
  • Stockton, CA
  • NPI 1194764472
  Medicare reassignment Care Compare group NPD
• Tim Fife, MD

  • Otolaryngology Physician
  • Roseville, CA
  • NPI 1073747663
  Medicare reassignment Care Compare group NPD
• Mudita Gogna, M.D.

  • Allergy & Immunology Physician
  • Roseville, CA
  • NPI 1235391640
  Medicare reassignment Care Compare group NPD
• Daniel R Goold, PAC

  • Physician Assistant
  • Fair Oaks, CA
  • NPI 1174308381
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778716800000",
    "number": "1497758155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 EXPOSITION BLVD BLDG 700",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958154314",
            "telephone_number": "916-736-3399",
            "fax_number": "916-233-4171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 EXPOSITION BLVD BLDG 700",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958154314",
            "telephone_number": "916-736-3399",
            "fax_number": "916-736-3350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "785 Hana Way Ste 102",
            "address_purpose": "LOCATION",
            "city": "Folsom",
            "state": "CA",
            "postal_code": "956303885",
            "country_code": "US",
            "telephone_number": "916-736-6644",
            "fax_number": "916-774-0143",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6600 Mercy Ct Ste 180A",
            "address_purpose": "LOCATION",
            "city": "Fair Oaks",
            "state": "CA",
            "postal_code": "956283198",
            "country_code": "US",
            "telephone_number": "916-966-2700",
            "fax_number": "916-966-0749",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1561 Creekside Dr Ste 180",
            "address_purpose": "LOCATION",
            "city": "Folsom",
            "state": "CA",
            "postal_code": "956303495",
            "country_code": "US",
            "telephone_number": "916-984-8830",
            "fax_number": "916-984-8834",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 Medical Plaza Dr Ste 225",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "CA",
            "postal_code": "956613044",
            "country_code": "US",
            "telephone_number": "916-782-1291",
            "fax_number": "916-782-5992",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6600 Mercy Ct Ste 180",
            "address_purpose": "LOCATION",
            "city": "Fair Oaks",
            "state": "CA",
            "postal_code": "956283198",
            "country_code": "US",
            "telephone_number": "916-966-2770",
            "fax_number": "916-966-0749",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1528 Eureka Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "CA",
            "postal_code": "956613047",
            "country_code": "US",
            "telephone_number": "916-736-6644",
            "fax_number": "916-774-0143",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10200 Trinity Pkwy Ste 201",
            "address_purpose": "LOCATION",
            "city": "Stockton",
            "state": "CA",
            "postal_code": "952197288",
            "country_code": "US",
            "telephone_number": "209-952-0483",
            "fax_number": "209-478-5785",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5 Medical Plaza Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "CA",
            "postal_code": "956612866",
            "country_code": "US",
            "telephone_number": "916-969-6071",
            "fax_number": "916-736-6638",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SACRAMENTO EAR NOSE & THROAT SURGICAL & MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2026-05-14",
        "certification_date": "2026-05-14",
        "status": "A",
        "authorized_official_last_name": "LI",
        "authorized_official_first_name": "NINA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "916-736-3399",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "CP5499",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0010460",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sacramento Ear, Nose, & Throat",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Otolaryngology Physician in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Otolaryngology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.