NPIMap

Organization Active NPI

Summit Nephrology Medical Group, Inc

  • Nephrology Physician
  • Roseville, CA
National Provider Identifier
1962575449
Registry record updated Apr 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A107520 Issued in CA
Legal business name
SUMMIT NEPHROLOGY MEDICAL GROUP, INC
Practice address
151 N Sunrise Ave
Ste. 1205
Roseville, CA 95661-2926
Phone
(916) 789-1505
Fax
(916) 789-1513
NPI assigned
Nov 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2019

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

Authorized official

Name
Dr. Adarsh Bhat, M.D.NPI 1861443228
Title
C.O.O.
Phone
(916) 789-1505

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 8

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RN0300X 20A7602 CA
Nephrology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RN0300X A72684 CA
Nephrology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RN0300X A69494 CA
Nephrology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RN0300X A92471 CA
Nephrology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RN0300X A117327 CA
Nephrology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RN0300X A92610 CA
Nephrology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RN0300X A107133 CA
Nephrology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RN0300X A107520 CA Primary

Addresses

Primary practice location

151 N Sunrise Ave
Ste. 1205
Roseville, CA 95661-2926

Mailing address

151 N Sunrise Ave
Ste. 1205
Roseville, CA 95661-2926
Phone (916) 789-1505

Other identifiers 1

IdentifierTypeStateIssuer
GR0100970MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050729001008 CA Part B Supplier - Clinic/Group Practice 9638107733 Receives reassigned benefits from 13 practitioners
Practice locations: Roseville, CA; Grass Valley, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1020429Summit Nephrology Medical Group Inc151 N Sunrise Ave Ste 1205, Roseville, CA 95661Provider-performed microscopyDec 17, 2027

National Provider Directory

National Provider Directory

Locations

360 Crown Point Cir
Ste 210
Grass Valley, CA 95945
Phone (530) 477-0734

10044 Wolf Rd
Ste A
Grass Valley, CA 95949
Phone (530) 268-7708

360 Crown Point Cir
Grass Valley, CA 95945

10058 Wolf Rd
Grass Valley, CA 95949
Phone (530) 268-0847

1451 Secret Ravine Pkwy
Ste 130
Roseville, CA 95661
Phone (916) 724-2595

10 Sierra Gate Plz
Ste 160
Roseville, CA 95678
Phone (916) 773-1880

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

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554768000000",
    "number": "1962575449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 N SUNRISE AVE",
            "address_2": "STE. 1205",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956612926",
            "telephone_number": "916-789-1505",
            "fax_number": "916-789-1513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 N SUNRISE AVE",
            "address_2": "STE. 1205",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956612926",
            "telephone_number": "916-789-1505",
            "fax_number": "916-789-1513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT NEPHROLOGY MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2019-04-09",
        "status": "A",
        "authorized_official_last_name": "BHAT",
        "authorized_official_first_name": "ADARSH",
        "authorized_official_title_or_position": "C.O.O.",
        "authorized_official_telephone_number": "916-789-1505",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "20A7602",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A72684",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A69494",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A92471",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A117327",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A92610",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A107133",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A107520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0100970",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.