Individual provider Active NPI

Aieska De Souza, MD, MSC

  • Dermatology Physician
  • Elk Grove, CA
National Provider Identifier
1770733446
Registry record updated Sep 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A137775 Issued in CA
Practice address
8220 Wymark Dr
Elk Grove, CA 95757-6297
Phone
(916) 667-0600
Fax
(916) 683-0232
NPI assigned
Sep 30, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 250593 MA
Dermatology Physician 207N00000X A137775 CA Primary

Addresses

Primary practice location

8220 Wymark Dr
Elk Grove, CA 95757-6297

Mailing address

3400 Data Dr
Credentialing
Rancho Cordova, CA 95670-7956

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151026002423 CA Practitioner - Dermatology 5991958217 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

2261 Douglas Blvd
Roseville, CA 95661-3831
Phone (916) 791-0900

2800 L St
Sacramento, CA 95816-5616

Hospital & facility affiliations

  • Sutter Roseville Medical Center Hospital, Roseville, CA, CCN 050309
  • Sutter Medical Center, Sacramento Hospital, Sacramento, CA, CCN 050108
  • Sutter Auburn Faith Hospital Hospital, Auburn, CA, CCN 050498

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1361
Removal of nail tissue1-10
Removal or shaving of skin growth29
Skin biopsy497

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A137775CAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation CurrentSince Jun 19, 2017 Accepting new patients
Sutter Valley Medical Foundation CurrentSince Jun 19, 2017 Accepting new patients
Sutter Valley Medical Foundation Dermatology Current Accepting new patients
Sutter North Medical Foundation Past Accepting new patients

Locations

2261 Douglas Blvd
Roseville, CA 95661
Phone (916) 783-1044

3 Medical Plaza Dr
Ste 230
Roseville, CA 95661
Phone (916) 797-4766

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

Interoperability endpoints

  • Direct secure messaging: adesouza342451@hisp.ehr.sutterhealth.org

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442534400000",
    "number": "1770733446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "address_2": "CREDENTIALING",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8220 WYMARK DR",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957576297",
            "telephone_number": "916-667-0600",
            "fax_number": "916-683-0232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE SOUZA",
        "first_name": "AIESKA",
        "name_prefix": "Dr.",
        "credential": "MD, MSC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-30",
        "last_updated": "2015-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MA",
            "license": "250593",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A137775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Grove, CA

Sources for this page

Verify at the official NPI Registry.