NPIMap

Individual provider Active NPI

Shirley Sandy Koon, D.O.

  • Internal Medicine Physician
  • Sacramento, CA
National Provider Identifier
1861716805
Registry record updated Aug 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20A14866 Issued in CA
Practice address
1201 Alhambra Blvd
Suite 220
Sacramento, CA 95816-5238
Phone
(916) 731-7925
Fax
(916) 731-7975
NPI assigned
Mar 19, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 11, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X OP60389702 WA
Internal Medicine Physician 207R00000X 20A14866 CA Primary

Addresses

Primary practice location

1201 Alhambra Blvd
Suite 220
Sacramento, CA 95816-5238

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
P01230600OtherWARAILROAD MDC

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
I20160927001545 CA Practitioner - Internal Medicine 4587800669 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Western University of Health Sciences College of Dental Med, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

2800 L St
Sacramento, CA 95816-5616

Hospital & facility affiliations

  • Sutter Care at Home Home health agency, Roseville, CA, CCN 057545
  • Sutter Roseville Medical Center Hospital, Roseville, CA, CCN 050309
  • Sutter Medical Center, Sacramento Hospital, Sacramento, CA, CCN 050108
  • Sutter Auburn Faith Hospital Hospital, Auburn, CA, CCN 050498

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A14866CAMDInternal Medicine Physician
OP60389702WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation CurrentSince Oct 10, 2016 Accepting new patients
Sutter Valley Medical Foundation Internal Medicine CurrentSince Oct 10, 2016 Accepting new patients
Sutter Valley Medical Foundation Internal Medicine Current Accepting new patients
Sutter North Medical Foundation Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients

Locations

2 Medical Plaza Dr
Ste 200
Roseville, CA 95661
Phone (916) 782-5106

1620 E Roseville Pkwy
Ste 110
Roseville, CA 95661
Phone (916) 797-4715

10470 Old Placerville Rd
Ste 100
Sacramento, CA 95827

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

1201 Alhambra Blvd
Ste 220
Sacramento, CA 95816
Phone (916) 731-7925

Interoperability endpoints

  • Direct secure messaging: shirley.koon@direct.vmmc.org
  • Direct secure messaging: skoon13965@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 5

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": "1268956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470873600000",
    "number": "1861716805",
    "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": "1201 ALHAMBRA BLVD",
            "address_2": "SUITE 220",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958165238",
            "telephone_number": "916-731-7925",
            "fax_number": "916-731-7975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOON",
        "first_name": "SHIRLEY",
        "middle_name": "SANDY",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-19",
        "last_updated": "2016-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "OP60389702",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A14866",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MDC",
            "identifier": "P01230600",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.