Organization Active NPI

Sierra Infectious Diseases a Professional Medical Corporation

  • Infectious Disease Physician
  • Fair Oaks, CA
National Provider Identifier
1629185418
Registry record updated Nov 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
A41552 Issued in CA
Legal business name
SIERRA INFECTIOUS DISEASES A PROFESSIONAL MEDICAL CORPORATION
Practice address
6614 Mercy CT
Suite a
Fair Oaks, CA 95628-3167
Phone
(916) 536-1136
Fax
(916) 536-1148
NPI assigned
Aug 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2014

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

Authorized official

Name
Dr. Elizabeth J Kailath, MDNPI 1952372765
Title
Physician
Phone
(916) 536-1136

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X A41552 CA
Infectious Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0200X A41552 CA Primary

Addresses

Primary practice location

6614 Mercy CT
Suite a
Fair Oaks, CA 95628-3167

Mailing address

6614 Mercy CT
Suite a
Fair Oaks, CA 95628-3167
Phone (916) 536-1136

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051206000495 CA Part B Supplier - Clinic/Group Practice 9234122169 Receives reassigned benefits from 1 practitioner
Practice locations: Fair Oaks, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0671388Sierra Infectious Diseases,6614 Mercy CT Ste a, Fair Oaks, CA 95628Certificate of waiverDec 30, 2027

National Provider Directory

National Provider Directory

Locations

6614 Mercy Ct
Ste A
Fair Oaks, CA 95628
Phone (916) 536-1136

Practitioners & affiliated clinicians

Practitioners 1

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": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416960000000",
    "number": "1629185418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6614 MERCY CT",
            "address_2": "SUITE A",
            "city": "FAIR OAKS",
            "state": "CA",
            "postal_code": "956283167",
            "telephone_number": "916-536-1136",
            "fax_number": "916-536-1148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6614 MERCY CT",
            "address_2": "SUITE A",
            "city": "FAIR OAKS",
            "state": "CA",
            "postal_code": "956283167",
            "telephone_number": "916-536-1136",
            "fax_number": "916-536-1148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIERRA INFECTIOUS DISEASES A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2014-11-26",
        "status": "A",
        "authorized_official_last_name": "KAILATH",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "916-536-1136",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A41552",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "CA",
            "license": "A41552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fair Oaks, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.