Individual provider Active NPI

Robert Ellsworth Young II, M.D.

  • Obstetrics & Gynecology Physician
  • Jackson, CA
National Provider Identifier
1790777662
Registry record updated Jun 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
G86327 Issued in CA
Practice address
100 Mission Blvd
Suite 2800
Jackson, CA 95642-2536
Phone
(209) 257-0177
Fax
(209) 257-0176
NPI assigned
Aug 17, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X G86327 CA Primary

Addresses

Primary practice location

100 Mission Blvd
Suite 2800
Jackson, CA 95642-2536

Mailing address

10470 Old Placerville Rd
Suite 100
Sacramento, CA 95827-2539
Phone (800) 470-0071

Other identifiers 1

IdentifierTypeStateIssuer
00G863270MedicaidCA

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
I20031223000490 CA Practitioner - Obstetrics/Gynecology 6507761277 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Virginia Commonwealth University, School of Medicine, 1975
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)

2800 L St
Suite 500
Sacramento, CA 95816-5616
Phone (916) 454-6868

Hospital & facility affiliations

  • Sutter Amador Hospital Hospital, Jackson, CA, CCN 050014

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation Current Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
Mark Twain Medical Center Past Accepting new patients
Sutter North Medical Foundation Past Accepting new patients
Emma L. Bixby Medical Center Past Accepting new patients

Locations

800 E Washington Blvd
Crescent City, CA 95531
Phone (707) 464-8511

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

Interoperability endpoints

  • Direct secure messaging: ryoung114574@hisp.ehr.sutterhealth.org

Organizations & group practices 5

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 1

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": "1124236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435536000000",
    "number": "1790777662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10470 OLD PLACERVILLE RD",
            "address_2": "SUITE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272539",
            "telephone_number": "800-470-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MISSION BLVD",
            "address_2": "SUITE 2800",
            "city": "JACKSON",
            "state": "CA",
            "postal_code": "956422536",
            "telephone_number": "209-257-0177",
            "fax_number": "209-257-0176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "ROBERT",
        "middle_name": "ELLSWORTH",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-17",
        "last_updated": "2015-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "G86327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G863270",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, CA

Sources for this page

Verify at the official NPI Registry.