NPIMap

Organization Active NPI

Saint Marys Medical Group Inc.

Doing business as Saint Mary's Clinic at Walmart

  • Clinic/Center
  • Sparks, NV
National Provider Identifier
1861757577
Registry record updated Nov 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SAINT MARYS MEDICAL GROUP INC.
Doing business as
Saint Mary's Clinic at Walmart
Practice address
5065 Pyramid Way
Sparks, NV 89436-7703
Phone
(775) 770-7664
Fax
(775) 770-7358
NPI assigned
Jul 9, 2012
Last updated
Nov 21, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2013

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

Authorized official

Name
Radha Savitala
Title
Deputy General Counsel
Phone
(909) 235-4308

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

5065 Pyramid Way
Sparks, NV 89436-7703

Mailing address

645 N Arlington Ave
Suite 555
Reno, NV 89503-4460
Phone (775) 770-7661

Other names 1

  • Saint Mary's Clinic at Walmart Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130422000013 NV Part B Supplier - Clinic/Group Practice 7618113523 Receives reassigned benefits from 62 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Reno, NV; Sparks, NV

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

645 N Arlington Ave
Ste 460
Reno, NV 89503
Phone (775) 770-7404

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384992000000",
    "number": "1861757577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 N ARLINGTON AVE",
            "address_2": "SUITE 555",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895034460",
            "telephone_number": "775-770-7661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5065 PYRAMID WAY",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894367703",
            "telephone_number": "775-770-7664",
            "fax_number": "775-770-7358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT MARYS MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-09",
        "last_updated": "2013-11-21",
        "status": "A",
        "authorized_official_last_name": "SAVITALA",
        "authorized_official_first_name": "RADHA",
        "authorized_official_title_or_position": "DEPUTY GENERAL COUNSEL",
        "authorized_official_telephone_number": "909-235-4308"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saint Mary's Clinic at Walmart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sparks, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2013; 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.