Teodoro P. Nissen M.D., Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

A77901 Issued in CA

Legal business name

TEODORO P. NISSEN M.D., INC

Practice address

1460 N Camino Alto Ste 201
Vallejo, CA 94589-2567

Phone

(707) 645-7210

Fax

(707) 645-7249

NPI assigned

Mar 11, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Teodoro Pedro Nissen, MDNPI 1699791053

Title

Ceo

Phone

(707) 645-7210

Specialties & licenses 1

Addresses

Other names 1

• Bay Area Orthopedic Surgery and Sports Medicine Other name

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Teodoro P Nissen, M.D.

  • Orthopaedic Surgery Physician
  • Vallejo, CA
  • NPI 1699791053
  Medicare reassignment Care Compare group NPD Authorized official
• Joseph Michael Centeno, MD

  • Surgery Physician
  • Napa, CA
  • NPI 1124086137
  Medicare reassignment Care Compare group NPD
• Cynthia Tanner Keane, RN

  • Registered Nurse
  • Vallejo, CA
  • NPI 1972908358
  NPD
• Natalia Balytsky, M.D.

  • Anesthesiology Physician
  • Santa Rosa, CA
  • NPI 1326146705
  NPD (past)
• Elizabeth Milne, PA-C

  • Physician Assistant
  • Fairfield, CA
  • NPI 1144373937
  NPD (past)

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

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770854400000",
    "number": "1629248109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 N CAMINO ALTO STE 201",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892567",
            "telephone_number": "707-645-7210",
            "fax_number": "707-645-7249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 N CAMINO ALTO STE 201",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892567",
            "telephone_number": "707-645-7210",
            "fax_number": "707-645-7249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEODORO P. NISSEN M.D., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-11",
        "last_updated": "2026-02-12",
        "certification_date": "2026-02-12",
        "status": "A",
        "authorized_official_last_name": "NISSEN",
        "authorized_official_first_name": "TEODORO",
        "authorized_official_middle_name": "PEDRO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "707-645-7210",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A77901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bay Area Orthopedic Surgery and Sports Medicine",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Bay Area Orthopedic Surgery and Sports Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Alex Sergy Ternavsky, RRT

• Specialist in Vallejo, CA
• Providers in Vallejo, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2026; 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.