NPIMap

Organization Active NPI

Active Life Wound Clinic a Professional Nursing Corporation

  • Nurse Practitioner
  • Sacramento, CA
National Provider Identifier
1801253323
Registry record updated Apr 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
ACTIVE LIFE WOUND CLINIC A PROFESSIONAL NURSING CORPORATION
Practice address
2 Scripps Dr Ste 202
Sacramento, CA 95825-6207
Phone
(916) 436-3015
NPI assigned
Jan 28, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2025

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

Authorized official

Name
Jeff Souza
Title
President
Phone
(916) 436-3015

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

2 Scripps Dr Ste 202
Sacramento, CA 95825-6207

Mailing address

PO Box 661587
Sacramento, CA 95866-1587

Other practice location 1

1526 Plumas Ct Ste 250
Yuba City, CA 95991-2961
Phone (888) 525-0255

Other practice location 2

406 Sunrise Ave Ste 250
Roseville, CA 95661-4147
Phone (916) 957-1840

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180130000241 CA Part B Supplier - Clinic/Group Practice 9436419017 Receives reassigned benefits from 13 practitioners
Practice locations: Sacramento, CA; Yuba City, CA; Roseville, CA

National Provider Directory

National Provider Directory

Locations

87 Scripps Dr
Ste 116
Sacramento, CA 95825
Phone (916) 436-3015

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1453939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744675200000",
    "number": "1801253323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 661587",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958661587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SCRIPPS DR STE 202",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958256207",
            "telephone_number": "916-436-3015"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1526 Plumas Ct Ste 250",
            "address_purpose": "LOCATION",
            "city": "Yuba City",
            "state": "CA",
            "postal_code": "959912961",
            "country_code": "US",
            "telephone_number": "888-525-0255",
            "fax_number": "888-525-1585",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "406 Sunrise Ave Ste 250",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "CA",
            "postal_code": "956614147",
            "country_code": "US",
            "telephone_number": "916-957-1840",
            "fax_number": "916-957-1885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ACTIVE LIFE WOUND CLINIC A PROFESSIONAL NURSING CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-28",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A",
        "authorized_official_last_name": "SOUZA",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-436-3015"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Apr 15, 2025; 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.