NPIMap

Organization Active NPI

Eye Site Sacramento Medical Group, Inc

  • Eyewear Supplier
  • Sacramento, CA
National Provider Identifier
1578866893
Registry record updated Dec 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
EYE SITE SACRAMENTO MEDICAL GROUP, INC
Practice address
4925 J St
Sacramento, CA 95819-3828
Phone
(916) 452-8105
Fax
(916) 452-4659
NPI assigned
Dec 8, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2010

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

Authorized official

Name
Ms. Susan M Van Duyn
Title
Manager
Phone
(916) 452-8105

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

4925 J St
Sacramento, CA 95819-3828

Mailing address

4925 J St
Sacramento, CA 95819-3828
Phone (916) 452-8105

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040123000354 CA Part B Supplier - Clinic/Group Practice 1951203504 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
Practice locations: Sacramento, CA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1291766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291766400000",
    "number": "1578866893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4925 J ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958193828",
            "telephone_number": "916-452-8105",
            "fax_number": "916-452-4659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4925 J ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958193828",
            "telephone_number": "916-452-8105",
            "fax_number": "916-452-4659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SITE SACRAMENTO MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-08",
        "last_updated": "2010-12-08",
        "status": "A",
        "authorized_official_last_name": "VAN DUYN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "916-452-8105",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Dec 8, 2010; 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.