Individual provider Active NPI

Dominic Le

  • Psychiatry Physician
  • Sacramento, CA
National Provider Identifier
1902433543
Registry record updated Aug 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A177665 Issued in CA
Practice address
2230 Stockton Blvd RM 202
Sacramento, CA 95817-1353
Phone
(916) 703-6756
NPI assigned
Mar 24, 2020
Last updated
Aug 1, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X A177665 CA Primary

Addresses

Primary practice location

2230 Stockton Blvd RM 202
Sacramento, CA 95817-1353

Mailing address

414 Branham LN E
San Jose, CA 95111-2761

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241015004188 CA Practitioner - Psychiatry 9133586779 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Loyola University of Chicago, Stritch School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Regents of the Univ of CaGroup PAC ID 3375456619, 1,571 clinicians

Practice addresses (Care Compare)

14264 Innovation Dr
Folsom, CA 95630-4099
Phone (916) 985-9300

2230 Stockton Blvd
Sacramento, CA 95817-1353
Phone (916) 734-3574

2315 Stockton Blvd
Sacramento, CA 95817-2201
Phone (916) 734-2011

2400 Del Paso Rd
Suite 145
Sacramento, CA 95834-9629
Phone (916) 928-3940

4860 Y St
Sacramento, CA 95817-2307

4861 Y St
Sacramento, CA 95817-2307
Phone (916) 734-2525

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.11 of 100Reported as group
Quality
86.24
Promoting interoperability
100
Improvement activities
40
Cost
78.35

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A177665CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California CurrentSince Sep 18, 2024 Accepting new patients
Regents of the Univ of Ca Current Accepting new patients
Regents of the University of Ca Psychiatry CurrentSince Sep 18, 2024 Accepting new patients
Regents of the Univ of Ca CurrentSince Sep 18, 2024 Accepting new patients
Regents of the University of California CurrentSince Sep 18, 2024 Accepting new patients

Locations

14264 Innovation Dr
Folsom, CA 95630
Phone (916) 946-9300

271 Turn Pike Dr
Folsom, CA 95630
Phone (916) 985-9200

10850 White Rock Rd
Rancho Cordova, CA 95670

2230 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-2614

2230 Stockton Blvd
Rm 202
Sacramento, CA 95817
Phone (916) 703-6756

2315 Stockton Blvd
Sacramento, CA 95817
Phone (916) 703-3030

2400 Del Paso Rd
Ste 145
Sacramento, CA 95834
Phone (916) 928-3940

4860 Y St
Ste 200
Sacramento, CA 95817
Phone (916) 734-3761

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1902433543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 BRANHAM LN E",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951112761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 STOCKTON BLVD RM 202",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958171353",
            "telephone_number": "916-703-6756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "DOMINIC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-24",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A177665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.