NPIMap

Organization Active NPI

Vitreo-Retinal Medical Group, Inc.

  • Ophthalmology Physician
  • Sacramento, CA
National Provider Identifier
1821181850
Registry record updated Apr 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
VITREO-RETINAL MEDICAL GROUP, INC.
Doing business as
Retinal Consultants Medical Group, Inc.
Practice address
3939 J St Ste 106
Sacramento, CA 95819-3631
Phone
(916) 454-4861
Fax
(916) 454-3603
NPI assigned
Oct 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2008

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

Authorized official

Name
Mr. Chris Mentink
Title
Practice Administrator
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 106
Sacramento, CA 95819-3631

Mailing address

3939 J St Ste 104
Sacramento, CA 95819-3631
Phone (916) 454-6191

Other identifiers 4

IdentifierTypeStateIssuer
GR0030320MedicaidCA
ZZZ82386ZOtherCABLUE SHIELD CA
0199873OtherWASAC. -DEPT. OF LABOR WA
CP5300OtherCASAC. OFFICE -RAILROAD MED

Other names 1

  • Retinal Consultants Medical Group, Inc. Doing business as

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

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207267200000",
    "number": "1821181850",
    "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": "916-454-6191",
            "fax_number": "916-454-1036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 J ST STE 106",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958193631",
            "telephone_number": "916-454-4861",
            "fax_number": "916-454-3603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITREO-RETINAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2008-04-04",
        "status": "A",
        "authorized_official_last_name": "MENTINK",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "916-453-5450",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030320",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD CA",
            "identifier": "ZZZ82386Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SAC. -DEPT. OF LABOR WA",
            "identifier": "0199873",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SAC. OFFICE -RAILROAD MED",
            "identifier": "CP5300",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Retinal Consultants Medical Group, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 4, 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.