NPIMap

Organization Active NPI

Capital OB/GYN, Inc.

  • Obstetrics & Gynecology Physician
  • Sacramento, CA
National Provider Identifier
1730136680
Registry record updated Sep 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
CAPITAL OB/GYN, INC.
Practice address
77 Cadillac Dr
Suite 230
Sacramento, CA 95825-5453
Phone
(916) 920-2082
Fax
(916) 920-1430
NPI assigned
May 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2011

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

Authorized official

Name
Bruce Alan Bob, M.D
Title
Vice President
Phone
(916) 920-2109

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

77 Cadillac Dr
Suite 230
Sacramento, CA 95825-5453

Mailing address

77 Cadillac Dr
Suite 230
Sacramento, CA 95825-5453
Phone (916) 920-2082

Other identifiers 1

IdentifierTypeStateIssuer
GR0101650MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061027000244 CA Part B Supplier - Clinic/Group Practice 3779580196 Receives reassigned benefits from 29 practitioners
Practice locations: Sacramento, CA; West Sacramento, 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
05D0698888Capital OB/GYN Inc77 Cadillac Dr 230, Sacramento, CA 95825Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory

Locations

77 Cadillac Dr
Sacramento, CA 95825
Phone (916) 734-3456

3941 J St
Sacramento, CA 95819
Phone (916) 453-4458

2101 Stone Blvd
Ste 110
West Sacramento, CA 95691
Phone (916) 920-2082

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314921600000",
    "number": "1730136680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 CADILLAC DR",
            "address_2": "SUITE 230",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958255453",
            "telephone_number": "916-920-2082",
            "fax_number": "916-920-1430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 CADILLAC DR",
            "address_2": "SUITE 230",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958255453",
            "telephone_number": "916-920-2082",
            "fax_number": "916-920-1430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITAL OB/GYN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2011-09-02",
        "status": "A",
        "authorized_official_last_name": "BOB",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "916-920-2109",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0101650",
            "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 Sep 2, 2011; 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.