Individual provider Active NPI

Peter Daniel Jurisich, D.O.

  • Cardiovascular Disease Physician
  • Roseville, CA
National Provider Identifier
1629083407
Registry record updated Feb 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
20A8542 Issued in CA
Practice address
2 Medical Plaza Dr Ste 175
Roseville, CA 95661-3049
Phone
(916) 782-2146
NPI assigned
Jul 30, 2006
Last updated
Feb 28, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology Physician 207RC0001X 20A8542 CA
Cardiovascular Disease Physician 207RC0000X 20A8542 CA Primary

Addresses

Primary practice location

2 Medical Plaza Dr Ste 175
Roseville, CA 95661-3049

Mailing address

2 Medical Plaza Dr Ste 175
Roseville, CA 95661-3049
Phone (916) 782-2146

Other identifiers 12

IdentifierTypeStateIssuer
00AX85420MedicaidCA
1671625OtherCAGREAT WEST
7450546OtherCAAETNA
020A85420OtherCABLUE SHIELD
2361104OtherCAUNITED HEALTHCARE
4911481OtherCACIGNA
95883OtherCAINTERPLAN
2121684OtherCAFIRST HEALTH
90136861OtherCAPACIFICARE
000810778930OtherCAPHCS
102287OtherCAHEALTH NET
20A542OtherCABLUE CROSS

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061114000562 CA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Other (Physician)Practitioner - Cardiac Electrophysiology 4385642982 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Cardiac Electrophysiology
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

1 Medical Plaza Dr
Roseville, CA 95661-3037
Phone (916) 454-6868

100 Mission Blvd
Jackson, CA 95642-2536

2 Medical Plaza Dr
Roseville, CA 95661-3042

2 Medical Plaza Dr
Suite 205
Roseville, CA 95661-3044
Phone (916) 773-8711

2575 E Bidwell St
Suite 100
Folsom, CA 95630-6445
Phone (916) 817-3710

2800 L St
Sacramento, CA 95816-5616

2825 Capitol Ave
Sacramento, CA 95816-6039
Phone (916) 454-6600

3288 Bell Rd
Auburn, CA 95603-9243
Phone (530) 886-2300

3320 Bell Rd
Auburn, CA 95603-9243
Phone (530) 888-1266

5765 Greenback LN
Sacramento, CA 95841-2013
Phone (916) 865-1040

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
8542CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation Family Medicine CurrentSince Feb 1, 2022 Accepting new patients
Roseville Cardiology Medical Associates, Inc. Cardiovascular Disease CurrentSince Jan 15, 2014 Accepting new patients
Sutter Valley Medical Foundation CurrentSince Feb 1, 2022 Accepting new patients
Sutter Tracy Community Hospital Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Ukiah Adventist Hospital Past Accepting new patients
Dignity Health Past Accepting new patients
Port City Operating Company, LLC Past Accepting new patients
Dameron Hospital Association Cardiovascular Disease Past Accepting new patients
Sutter Regional Medical Foundation Family Medicine Past Accepting new patients
Oroville Hospital Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
Lodi Memorial Hospital Association Inc Past Accepting new patients
Dignity Health Past Accepting new patients

Locations

3288 Bell Rd
Auburn, CA 95603
Phone (530) 886-2300

685 Twelve Bridges Dr
Ste G
Lincoln, CA 95648
Phone (916) 408-5478

2 Medical Plaza Dr
Ste 175
Roseville, CA 95661
Phone (916) 782-2146

2 Medical Plaza Dr
Ste 250
Roseville, CA 95661
Phone (916) 786-3824

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

Interoperability endpoints

  • Direct secure messaging: pjurisich192626@hisp.ehr.sutterhealth.org

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393545600000",
    "number": "1629083407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 MEDICAL PLAZA DR STE 175",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613049",
            "telephone_number": "916-782-2146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MEDICAL PLAZA DR STE 175",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613049",
            "telephone_number": "916-782-2146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JURISICH",
        "first_name": "PETER",
        "middle_name": "DANIEL",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-30",
        "last_updated": "2014-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "CA",
            "license": "20A8542",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "20A8542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX85420",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT WEST",
            "identifier": "1671625",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7450546",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "020A85420",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2361104",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "4911481",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERPLAN",
            "identifier": "95883",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "2121684",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFICARE",
            "identifier": "90136861",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "000810778930",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "102287",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "20A542",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

Verify at the official NPI Registry.