Individual provider Active NPI

Nina C Joe, PA-C

  • Surgical Physician Assistant
  • Sacramento, CA
National Provider Identifier
1619901188
Registry record updated Feb 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA21411 Issued in CA
Practice address
3000 Q St
Sacramento, CA 95816-7058
Phone
(916) 733-5700
Fax
(916) 733-5714
NPI assigned
Jul 10, 2006
Last updated
Feb 4, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 0505P NH
Surgical Physician Assistant 363AS0400X PA21411 CA Primary

Addresses

Primary practice location

3000 Q St
Sacramento, CA 95816-7058

Mailing address

3400 Data Dr
Rancho Cordova, CA 95670-7956

Other identifiers 1

IdentifierTypeStateIssuer
30334232MedicaidNH

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
I20110714000560 CA Practitioner - Physician Assistant 7810948825 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Limberg Eye Surgery a Medical CorporationGroup PAC ID 4688661747, 4 clinicians

Practice addresses (Care Compare)

1270 Peach St
Suite 100
San Luis Obispo, CA 93401-2821
Phone (805) 541-1342

6195 Fremont Cir
Camarillo, CA 93012-4338
Phone (805) 541-1342

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
818OKMDSpeech-Language Pathologist
PA21411CAMDSurgical Physician Assistant
0505PNHMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health Past Accepting new patients

Organizations & group practices 2

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": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454544000000",
    "number": "1619901188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 Q ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958167058",
            "telephone_number": "916-733-5700",
            "fax_number": "916-733-5714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOE",
        "first_name": "NINA",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2016-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NH",
            "license": "0505P",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA21411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30334232",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.