NPIMap

Organization Active NPI

Spine & Nerve Diagnostic Center

  • Physical Medicine & Rehabilitation Physician
  • Elk Grove, CA
National Provider Identifier
1952770919
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
SPINE & NERVE DIAGNOSTIC CENTER
Practice address
2234 Longport CT Ste 100
Elk Grove, CA 95758-7181
Phone
(916) 478-0112
NPI assigned
Sep 21, 2015
Last updated
Jan 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Authorized official

Name
Vinay Moola Reddy, MDNPI 1548203961
Title
MD/President
Phone
(916) 772-5325

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X NU Primary

Addresses

Primary practice location

2234 Longport CT Ste 100
Elk Grove, CA 95758-7181

Mailing address

4200 Douglas Blvd
Granite Bay, CA 95746-5902
Phone (916) 772-5325

Other practice location 1

9245 Laguna Springs Dr Ste 140
Elk Grove, CA 95758-7991
Phone (916) 772-5325

Other identifiers 1

IdentifierTypeStateIssuer
CA143514OtherCAPTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150319001739 CA Part B Supplier - Clinic/Group Practice 9830416460 Receives reassigned benefits from 55 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Granite Bay, CA; Sacramento, CA; Roseville, CA; Lincoln, CA; Elk Grove, CA; Folsom, CA; Davis, CA

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

Locations

2234 Longport Ct
Ste 100
Elk Grove, CA 95758
Phone (916) 478-0112

2372 Maritime Dr
Elk Grove, CA 95758
Phone (408) 885-5110

1528 Eureka Rd
Ste 103
Roseville, CA 95661
Phone (916) 772-5325

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1442793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1952770919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 DOUGLAS BLVD",
            "city": "GRANITE BAY",
            "state": "CA",
            "postal_code": "957465902",
            "telephone_number": "916-772-5325",
            "fax_number": "916-772-6333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2234 LONGPORT CT STE 100",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957587181",
            "telephone_number": "916-478-0112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9245 Laguna Springs Dr Ste 140",
            "address_purpose": "LOCATION",
            "city": "Elk Grove",
            "state": "CA",
            "postal_code": "957587991",
            "country_code": "US",
            "telephone_number": "916-772-5325",
            "fax_number": "916-772-6333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPINE & NERVE DIAGNOSTIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-21",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A",
        "authorized_official_last_name": "REDDY",
        "authorized_official_first_name": "VINAY",
        "authorized_official_middle_name": "MOOLA",
        "authorized_official_title_or_position": "MD/PRESIDENT",
        "authorized_official_telephone_number": "916-772-5325",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "CA143514",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; 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.