NPIMap

Organization Active NPI

Vitreo-Retinal Medical Group, Inc.

Doing business as Retinal Consultants Medical Group, Inc

  • Ophthalmology Physician
  • Tracy, CA
National Provider Identifier
1710212782
Registry record updated Oct 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
VITREO-RETINAL MEDICAL GROUP, INC.
Doing business as
Retinal Consultants Medical Group, Inc
Practice address
1548 N Tracy Blvd
Tracy, CA 95376-2903
Phone
(916) 454-4861
Fax
(916) 454-3603
NPI assigned
Oct 8, 2009
Last updated
Oct 8, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2009

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

Authorized official

Name
Dr. Robert Wendel, M.D.NPI 1235234634
Title
President
Phone
(916) 453-5450

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

1548 N Tracy Blvd
Tracy, CA 95376-2903

Mailing address

3939 J St
Suite 104
Sacramento, CA 95819-3631
Phone (916) 454-6191

Other names 1

  • Retinal Consultants Medical Group, Inc Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050427000951 CA Part B Supplier - Clinic/Group Practice 5799672275 Receives reassigned benefits from 23 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Yuba City, CA; Tracy, CA; Fairfield, CA; Stockton, CA; Sacramento, CA; Roseville, CA; Merced, CA; Grass Valley, CA…

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory

Locations

1548 N Tracy Blvd
Tracy, CA 95376
Phone (209) 461-5291

1870 Lassen Blvd
Ste B
Yuba City, CA 95993
Phone (530) 273-8358

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1254960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254960000000",
    "number": "1710212782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3939 J ST",
            "address_2": "SUITE 104",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958193631",
            "telephone_number": "916-454-6191",
            "fax_number": "916-454-1036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1548 N TRACY BLVD",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953762903",
            "telephone_number": "916-454-4861",
            "fax_number": "916-454-3603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITREO-RETINAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-08",
        "last_updated": "2009-10-08",
        "status": "A",
        "authorized_official_last_name": "WENDEL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-453-5450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Retinal Consultants Medical Group, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tracy, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2009; 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.