NPIMap

Organization Active NPI

Vitreo-Retinal Medical Group, Inc.

  • Ophthalmology Physician
  • Sacramento, CA
National Provider Identifier
1770646119
Registry record updated Jan 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
VITREO-RETINAL MEDICAL GROUP, INC.
Practice address
3939 J St Ste 104
Sacramento, CA 95819-3631
Phone
(916) 453-5450
Fax
(916) 454-1015
NPI assigned
Dec 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2008

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

Authorized official

Name
Dr. Robert T. Wendel, MD
Title
President
Phone
(916) 453-5450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

3939 J St Ste 104
Sacramento, CA 95819-3631

Mailing address

3939 J St Ste 104
Sacramento, CA 95819-3631
Phone (916) 453-5450

Other identifiers 7

IdentifierTypeStateIssuer
CP5300OtherCARAILROAD MEDICARE
GR0030322MedicaidCA
199873OtherWADEPT. OF LABOR WA
GR0030323MedicaidCA
GR0030320MedicaidCA
CP5300OtherCARAILROAD
GR0030321MedicaidCA

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

9381 E Stockton Blvd
Ste 160
Elk Grove, CA 95624

3185 M St
Ste 202
Merced, CA 95348

3199 M St
Merced, CA 95348
Phone (209) 646-5333

3555 Deer Park Dr
Ste 180
Stockton, CA 95219
Phone (209) 461-3390

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

1870 Lassen Blvd
Yuba City, CA 95993

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201219200000",
    "number": "1770646119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3939 J ST STE 104",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958193631",
            "telephone_number": "916-453-5450",
            "fax_number": "916-454-1015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 J ST STE 104",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958193631",
            "telephone_number": "916-453-5450",
            "fax_number": "916-454-1015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITREO-RETINAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2008-01-25",
        "status": "A",
        "authorized_official_last_name": "WENDEL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-453-5450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CP5300",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030322",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT. OF LABOR WA",
            "identifier": "199873",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030323",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030320",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "CP5300",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030321",
            "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 Jan 25, 2008; 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.