Individual provider Active NPI

Ethan Gabriel Cermeno, MD

  • Internal Medicine Physician
  • Sacramento, CA
National Provider Identifier
1538640776
Registry record updated Feb 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
18467 Issued in CA
Practice address
4150 V St # 1100
Sacramento, CA 95817-1460
Phone
(818) 438-8107
NPI assigned
Aug 26, 2018
Last updated
Feb 4, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 18467 CA Primary
Psychiatry Physician 2084P0800X 18467 CA

Addresses

Primary practice location

4150 V St # 1100
Sacramento, CA 95817-1460

Mailing address

4150 V St # 1100
Sacramento, CA 95817-1460
Phone (916) 734-2737

Other practice location 1

4610 X St
Sacramento, CA 95817-2200
Phone (916) 734-4111

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
I20250912003130 CA Practitioner - Psychiatry 2961806070 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of California, Davis School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

250 W Main St
Woodland, CA 95695-3652
Phone (916) 668-6100

2800 L St
Sacramento, CA 95816-5616

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation Internal Medicine Current Accepting new patients
Sutter Valley Medical Foundation CurrentSince Aug 1, 2025 Accepting new patients
Sutter Valley Medical Foundation Internal Medicine CurrentSince Aug 1, 2025 Accepting new patients
Sutter Regional Medical Foundation Internal Medicine Past Accepting new patients

Locations

2720 Low Ct
Fairfield, CA 94534
Phone (707) 428-2731

815 Court St
Ste 7
Jackson, CA 95642
Phone (209) 257-5900

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

1201 Alhambra Blvd
Ste 420
Sacramento, CA 95816
Phone (916) 731-7707

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

7919 Folsom Blvd
Ste 180
Sacramento, CA 95826
Phone (916) 887-7890

250 W Main St
Woodland, CA 95695
Phone (916) 668-6100

Interoperability endpoints

  • Direct secure messaging: ecermeno312454@direct.ochin.org
  • Direct secure messaging: ecermeno747730@hisp.ehr.sutterhealth.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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1535241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738627200000",
    "number": "1538640776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 V ST # 1100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958171460",
            "telephone_number": "916-734-2737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 V ST # 1100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958171460",
            "telephone_number": "818-438-8107"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4610 X St",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958172200",
            "country_code": "US",
            "telephone_number": "916-734-4111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CERMENO",
        "first_name": "ETHAN",
        "middle_name": "GABRIEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-08-26",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "18467",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "18467",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.