Individual provider Active NPI

Lyndsey Demelza Ackerman, NP

  • Pediatric Nurse Practitioner
  • Sacramento, CA
National Provider Identifier
1619630464
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
95018883 Issued in CA
Practice address
2315 Stockton Blvd
Sacramento, CA 95817-2201
Phone
(800) 282-3284
NPI assigned
Oct 19, 2021
Last updated
May 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 95018883 CA Primary

Addresses

Primary practice location

2315 Stockton Blvd
Sacramento, CA 95817-2201

Mailing address

612 Hibiscus CT
Brentwood, CA 94513-5567
Phone (952) 215-7357

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211118002261 CA Practitioner - Nurse Practitioner 0749679447 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regents of the Univ of CaGroup PAC ID 3375456619, 1,571 clinicians

Practice addresses (Care Compare)

2221 Stockton Blvd
Sacramento, CA 95817-1418
Phone (916) 734-2680

2315 Stockton Blvd
Sacramento, CA 95817-2201
Phone (916) 734-2011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95018883CAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the Univ of Ca Current Accepting new patients
University of California San Francisco CurrentSince Nov 12, 2021 Accepting new patients
UCSF Medical Group Business Services CurrentSince Nov 12, 2021 Accepting new patients
UCSF Pediatrics Associates CurrentSince Nov 12, 2021 Accepting new patients
Regents of the Univ of Ca CurrentSince May 29, 2024 Accepting new patients
UCSF Medical Group Business Services CurrentSince Nov 12, 2021 Accepting new patients
UCSF Dept of Surgery CurrentSince Nov 12, 2021 Accepting new patients
Regents of the Univ of Ca CurrentSince May 29, 2024 Accepting new patients
University of California San Francisco CurrentSince Nov 12, 2021 Accepting new patients
University of California San Francisco Current Accepting new patients
Regents of the Univ of Ca Past Accepting new patients

Locations

2221 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-2680

2315 Stockton Blvd
Sacramento, CA 95817
Phone (916) 703-3030

2521 Stockton Blvd
Ste 4100
Sacramento, CA 95817
Phone (916) 734-5846

1975 4th St
San Francisco, CA 94143
Phone (415) 353-3000

2330 Post St
San Francisco, CA 94115
Phone (415) 502-4444

3360 Geary Blvd
Ste 201
San Francisco, CA 94118
Phone (415) 353-3100

400 Parnassus Ave
#A632
San Francisco, CA 94143
Phone (415) 473-1000

505 Parnassus Ave
San Francisco, CA 94143
Phone (415) 476-9058

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1634601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1619630464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 HIBISCUS CT",
            "city": "BRENTWOOD",
            "state": "CA",
            "postal_code": "945135567",
            "telephone_number": "952-215-7357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 STOCKTON BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172201",
            "telephone_number": "800-282-3284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACKERMAN",
        "first_name": "LYNDSEY",
        "middle_name": "DEMELZA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-19",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "95018883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.