Active NPI
Kym Rynearson
- Substance Abuse Rehabilitation Facility
- Sacramento, CA
National Provider Identifier
1720470628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Substance Abuse Rehabilitation Facility
- License
- 94-1582683
- Practice address
- 4049 Miller Way
Sacramento, CA 95817-1332 - Phone
- (916) 451-9312
- Fax
- (916) 451-4018
- NPI assigned
- Mar 2, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | 94-1582683 | CA | Primary |
Addresses
Primary practice location
4049 Miller Way
Sacramento, CA 95817-1332
Mailing address
4049 Miller Way
Sacramento, CA 95817-1332
Phone (916) 451-9312
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R117281214 | Other | CA | AOD COUNSELOR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1425254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425254400000",
"number": "1720470628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4049 MILLER WAY",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958171332",
"telephone_number": "916-451-9312",
"fax_number": "916-451-4018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4049 MILLER WAY",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958171332",
"telephone_number": "916-451-9312",
"fax_number": "916-451-4018"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYNEARSON",
"first_name": "KYM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-03-02",
"last_updated": "2015-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "324500000X",
"taxonomy_group": "",
"desc": "Substance Abuse Rehabilitation Facility",
"state": "CA",
"license": "94-1582683",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AOD COUNSELOR",
"identifier": "R117281214",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.