NPIMap

Organization Active NPI

Tri-Valley Orthopedic and Sports Medical Group Inc

  • Orthopaedic Surgery Physician
  • Tracy, CA
National Provider Identifier
1609987254
Registry record updated Nov 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
TRI-VALLEY ORTHOPEDIC AND SPORTS MEDICAL GROUP INC
Practice address
2180 W Grant Line Rd
Suite 100
Tracy, CA 95377-7309
Phone
(209) 833-6821
Fax
(209) 833-3328
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2010

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

Authorized official

Name
Deborah Rhoton
Title
Billing Department Manager
Phone
(925) 469-0939

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary
Orthopaedic Hand Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0106X

Addresses

Primary practice location

2180 W Grant Line Rd
Suite 100
Tracy, CA 95377-7309

Mailing address

4626 Willow Rd
Suite 200
Pleasanton, CA 94588-2710
Phone (925) 469-0939

Other names 1

  • Tri-Valley Orthopedic Specialists Inc Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031219000786 CA Part B Supplier - Clinic/Group Practice 3577461151 Receives reassigned benefits from 29 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pleasanton, CA; San Ramon, CA; Tracy, CA
O20100930008928 CA DME Supplier - Physician - Orthopedic/Orthopedic SurgeryDME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 3577461151 Practice locations: Tracy, CA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

4626 Willow Rd
Ste 200
Pleasanton, CA 94588
Phone (925) 463-0470

5601 Norris Canyon Rd
Ste 130
San Ramon, CA 94583
Phone (925) 463-0470

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 10

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": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289174400000",
    "number": "1609987254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4626 WILLOW RD",
            "address_2": "SUITE 200",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945882710",
            "telephone_number": "925-469-0939",
            "fax_number": "925-469-0165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2180 W GRANT LINE RD",
            "address_2": "SUITE 100",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953777309",
            "telephone_number": "209-833-6821",
            "fax_number": "209-833-3328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-VALLEY ORTHOPEDIC AND SPORTS MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2010-11-08",
        "status": "A",
        "authorized_official_last_name": "RHOTON",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "BILLING DEPARTMENT MANAGER",
        "authorized_official_telephone_number": "925-469-0939"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri-Valley Orthopedic Specialists Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tracy, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.