Individual provider Active NPI

Denise Mathis

  • Registered Dietitian
  • Roseville, CA
National Provider Identifier
1760187512
Registry record updated May 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
850309 Issued in CA
Practice address
3100 Douglas Blvd Ste 204
Roseville, CA 95661-3868
Phone
(916) 774-8885
NPI assigned
Apr 3, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 850309 CA Primary

Addresses

Primary practice location

3100 Douglas Blvd Ste 204
Roseville, CA 95661-3868

Mailing address

PO Box 255228
Sacramento, CA 95865-5228

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230606002780 CA Practitioner - Registered Dietitian Or Nutrition Professional 3173980133 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

100 Hospital Dr
Vallejo, CA 94589-2580
Phone (707) 551-3600

2702 Low CT
Fairfield, CA 94534-9771
Phone (707) 432-2600

2720 Low CT
Fairfield, CA 94534-9771
Phone (707) 428-2731

2800 L St
Sacramento, CA 95816-5616

3100 Douglas Blvd
Roseville, CA 95661-3866
Phone (916) 774-8500

685 Twelve Bridges Dr
Lincoln, CA 95648-8689

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
850309CAMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation Current Accepting new patients
Sutter Valley Medical Foundation CurrentSince May 1, 2023 Accepting new patients
Sutter Valley Medical Foundation CurrentSince May 1, 2023 Accepting new patients
Sutter North Medical Foundation Past Accepting new patients

Locations

2720 Low Ct
Fairfield, CA 94534
Phone (707) 428-2731

815 Court St
Ste 7
Jackson, CA 95642
Phone (209) 257-5900

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

7 Medical Plaza Dr
Ste 420
Roseville, CA 95661

3100 Douglas Blvd
Roseville, CA 95661
Phone (916) 774-8300

3100 Douglas Blvd
Ste 204
Roseville, CA 95661
Phone (916) 772-7190

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

250 W Main St
Woodland, CA 95695
Phone (916) 668-6100

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1680480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685404800000",
    "number": "1760187512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 255228",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958655228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 DOUGLAS BLVD STE 204",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613868",
            "telephone_number": "916-774-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "DENISE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-03",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "850309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; 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.