Individual provider Active NPI

Jason Sam Vuong

  • Physician Assistant
  • Sacramento, CA
National Provider Identifier
1831977115
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA65793 Issued in CA
Practice address
4420 Duckhorn Dr Ste 200
Sacramento, CA 95834-2590
Phone
(916) 419-9900
NPI assigned
Sep 18, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA65793 CA Primary

Addresses

Primary practice location

4420 Duckhorn Dr Ste 200
Sacramento, CA 95834-2590

Mailing address

4420 Duckhorn Dr Ste 200
Sacramento, CA 95834-2590
Phone (916) 419-9900

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250515003141 CA Practitioner - Physician Assistant 4688192438 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA65793CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Spine & Nerve Diagnostic Center CurrentSince May 19, 2025 Accepting new patients
Spine & Nerve Diagnostic Center CurrentSince May 19, 2025 Accepting new patients

Locations

1528 Eureka Rd
Ste 103
Roseville, CA 95661
Phone (916) 772-5325

4420 Duckhorn Dr
Ste 200
Sacramento, CA 95834
Phone (916) 419-9900

Interoperability endpoints

  • Direct secure messaging: jvuong737121@hisp.ehr.sutterhealth.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1694995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747612800000",
    "number": "1831977115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4420 DUCKHORN DR STE 200",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958342590",
            "telephone_number": "916-419-9900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 DUCKHORN DR STE 200",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958342590",
            "telephone_number": "916-419-9900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VUONG",
        "first_name": "JASON",
        "middle_name": "SAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-18",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA65793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.