Individual provider Active NPI

Suttatip Vechvitvarakul, MD

  • Vascular Surgery Physician
  • Victorville, CA
National Provider Identifier
1902061716
Registry record updated Aug 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
A135920 Issued in CA
Practice address
15030 7TH St
Victorville, CA 92395-3811
Phone
(760) 951-0065
NPI assigned
Jul 21, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 3, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X A135920 CA Primary
Vascular Surgery Physician 2086S0129X 036125829 IL

Addresses

Primary practice location

15030 7TH St
Victorville, CA 92395-3811

Mailing address

15030 7TH St
Victorville, CA 92395-3811
Phone (760) 951-0065

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TN, TX3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20160121000914 CA Practitioner - Vascular Surgery 2860679776 Reassigns benefits to 5 organizations
I20241104003318 TN Practitioner - Vascular SurgeryPractitioner - General Surgery 2860679776 Reassigns benefits to 1 organization
I20260407004169 TX Practitioner - Vascular Surgery 2860679776 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Seton Family of DoctorsGroup PAC ID 0941333280, 785 clinicians

Practice addresses (Care Compare)

6001 Kyle Pkwy
Kyle, TX 78640-6112
Phone (512) 504-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A135920CAMDVascular Surgery Physician
036125829ILMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jan 20, 2022 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
West Tennessee Medical Group Inc CurrentSince Oct 1, 2024 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jan 20, 2022 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jan 20, 2022 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jan 20, 2022 Accepting new patients
Northbay Healthcare Group CurrentSince Sep 1, 2021 Accepting new patients
Northbay Healthcare Group CurrentSince Sep 1, 2021 Accepting new patients

Locations (25 of 29)

18400 US Highway 18
Apple Valley, CA 92307
Phone (760) 810-7590

1950 University Ave
Ste 160
East Palo Alto, CA 94303
Phone (650) 317-8100

1200 B Gale Wilson Blvd
Fairfield, CA 94533
Phone (707) 429-3600

3120 Kearney St
Fremont, CA 94538
Phone (650) 498-3600

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

1189 E Herndon Ave
Ste 103
Fresno, CA 93720
Phone (559) 450-7777

370 Distel Cir
Los Altos, CA 94022
Phone (650) 254-5200

715 Altos Oaks Dr
Los Altos, CA 94024
Phone (650) 934-7010

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

701 E El Camino Real
#1
Mountain View, CA 94040
Phone (650) 404-8440

101 Rowland Way
Ste 220
Novato, CA 94945
Phone (415) 878-7200

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

1555 East St
Ste 200
Redding, CA 96001
Phone (530) 229-0911

151 N Sunrise Ave
Ste 1205
Roseville, CA 95661
Phone (916) 789-1505

301 Industrial Rd
#1
San Carlos, CA 94070
Phone (650) 404-8455

3838 California St
Rm 410
San Francisco, CA 94118
Phone (415) 751-1847

2581 Samaritan Dr
Ste 308
San Jose, CA 95124
Phone (408) 355-1700

123 S San Mateo Dr
San Mateo, CA 94401
Phone (650) 343-4200

3883 Airway Dr
Ste 220
Santa Rosa, CA 95403
Phone (707) 521-7750

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

121 Sotoyome St
Ste 203
Santa Rosa, CA 95405
Phone (707) 525-4080

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

10200 Trinity Pkwy
Ste 101
Stockton, CA 95219
Phone (209) 323-3488

1000 Nut Tree Rd
Vacaville, CA 95687
Phone (707) 446-4000

550 S Green Valley Rd
Watsonville, CA 95076
Phone (831) 458-5865

Organizations & group practices 12

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 2

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": "1216598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438560000000",
    "number": "1902061716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15030 7TH ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923953811",
            "telephone_number": "760-951-0065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15030 7TH ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923953811",
            "telephone_number": "760-951-0065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VECHVITVARAKUL",
        "first_name": "SUTTATIP",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-21",
        "last_updated": "2015-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "A135920",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "IL",
            "license": "036125829",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.