NPIMap

Individual provider Active NPI

Larry Reynolds Feliciano, M.D.

  • Family Medicine Physician
  • Sacramento, CA
National Provider Identifier
1811965791
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A51153 Issued in CA
Practice address
7601 Hospital Dr
Sacramento, CA 95823-5408
Phone
(916) 689-1966
Fax
(916) 689-1238
NPI assigned
Mar 8, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A51153 CA Primary

Addresses

Primary practice location

7601 Hospital Dr
Sacramento, CA 95823-5408

Mailing address

7601 Hospital Drive # 209
Sacramento, CA 95823-5408
Phone (916) 689-1966

Other identifiers 1

IdentifierTypeStateIssuer
LAB12158FMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100813000662 CA Practitioner - Family Practice 4789718677 Practice locations: Sacramento, CA

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

7601 Hospital Dr
Suite 209
Sacramento, CA 95823-5408
Phone (916) 689-1966

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue38

National Provider Directory

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

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Elk Grove Post AcuteElk Grove, CA, CCN 055308 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 16, 2017
Jan 16, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Hospital & facility affiliations 8

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": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811965791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7601 HOSPITAL DRIVE # 209",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958235408",
            "telephone_number": "916-689-1966",
            "fax_number": "916-689-1238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 HOSPITAL DR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958235408",
            "telephone_number": "916-689-1966",
            "fax_number": "916-689-1238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELICIANO",
        "first_name": "LARRY",
        "middle_name": "REYNOLDS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A51153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB12158F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.