Individual provider Active NPI

Tatyana S Sarkisova, MD

  • Family Medicine Physician
  • Stockton, CA
National Provider Identifier
1902817182
Registry record updated Jan 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A105868 Issued in CA
Practice address
2505 W Hammer LN
Stockton, CA 95209-2839
Phone
(209) 957-7050
NPI assigned
Aug 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A105868 CA Primary
Family Medicine Physician 207Q00000X 01065551A IN

Addresses

Primary practice location

2505 W Hammer LN
Stockton, CA 95209-2839

Mailing address

600 Coffee Rd
Modesto, CA 95355-4201
Phone (209) 524-1211

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
I20090827000079 CA Practitioner - Family Practice 0840365557 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

3655 Lomita Blvd
Suite 108
Torrance, CA 90505-1902
Phone (310) 373-9768

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
105868CAMDGeneral Practice Dentistry
01065551AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tatyana Sarkisova MD, Inc Family Medicine CurrentSince Jun 19, 2019 Accepting new patients
Sutter Gould Medical Foundation Family Medicine Past Accepting new patients
Torrance Memorial Medical Center PastSince Aug 15, 2019 Accepting new patients
Fort Wayne Medical Education Program Family Medicine PastSince Sep 1, 2024 Accepting new patients

Locations

3655 Lomita Blvd
Ste 108
Torrance, CA 90505
Phone (310) 373-0250

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

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 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": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295913600000",
    "number": "1902817182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554201",
            "telephone_number": "209-524-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 W HAMMER LN",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952092839",
            "telephone_number": "209-957-7050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SARKISOVA",
        "first_name": "TATYANA",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2011-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A105868",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01065551A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.