Active NPI
Bryan L. Fandrich, MD
- Surgery Physician
- Sacramento, CA
National Provider Identifier
1548348238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- G53202
- Practice address
- 2025 Morse Ave
Sacramento, CA 95825-2115 - Phone
- (916) 973-5000
- NPI assigned
- Nov 1, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | G53202 | CA | Primary |
Addresses
Primary practice location
2025 Morse Ave
Sacramento, CA 95825-2115
Mailing address
1800 Harrison St FL 7
Oakland, CA 94612-3429
Phone (510) 625-6262
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G532020 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53202 | CA | MD | Pharmacist |
| G53202 | CA | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Loma Linda University Medical Center | Past | Accepting new patients | |
| Loma Linda University Health Care Inc | Surgery | Past | Accepting new patients |
| St. Mary Medical Center | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Acute Care Hospital
- Loma Linda, CA
- NPI 1194731935
-
dba Providence St. Mary Medical Center
- General Acute Care Hospital
- Apple Valley, CA
- NPI 1669456299
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1548348238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 HARRISON ST FL 7",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946123429",
"telephone_number": "510-625-6262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2025 MORSE AVE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958252115",
"telephone_number": "916-973-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANDRICH",
"first_name": "BRYAN",
"middle_name": "L.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "G53202",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G532020",
"state": "CA"
}
],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.