Individual provider Active NPI

Javar Van Buren

  • Pediatrics Physician
  • Sacramento, CA
National Provider Identifier
1508328600
Registry record updated Dec 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
180723 Issued in CA
Practice address
2516 Stockton Blvd
Sacramento, CA 95817-2208
Phone
(916) 734-2428
NPI assigned
Apr 5, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 180723 CA Primary

Addresses

Primary practice location

2516 Stockton Blvd
Sacramento, CA 95817-2208

Mailing address

2516 Stockton Blvd
Sacramento, CA 95817-2208
Phone (916) 734-2428

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220911000021 CA Practitioner - Pediatric Medicine 1254716319 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
180723CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Ca Pediatrics CurrentSince Jul 25, 2022 Accepting new patients
Regents of the Univ of Ca Current Accepting new patients
Regents of the Univ of Ca CurrentSince Jul 25, 2022 Accepting new patients

Locations

2521 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-1104

4900 Broadway
Ste 2800
Sacramento, CA 95820
Phone (916) 734-9313

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1554422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671148800000",
    "number": "1508328600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2516 STOCKTON BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172208",
            "telephone_number": "916-734-2428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2516 STOCKTON BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172208",
            "telephone_number": "916-734-2428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN BUREN",
        "first_name": "JAVAR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-05",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "180723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.