| Blossom Ridge Medical, Inc. | |
|
1420 River Park Dr Ste 120 Sacramento CA 95815-4506 | |
| (800) 991-6147 | |
| (916) 558-4747 |
| Full Name | Blossom Ridge Medical, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1420 River Park Dr Ste 120, Sacramento, California |
| Authorized Official Name and Position | Gerald Agustin (CEO) |
| Authorized Official Contact | 8009916147 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blossom Ridge Medical, Inc. 520 9th St Ste 240 Sacramento CA 95814-1327 Ph: (800) 991-6147 | Blossom Ridge Medical, Inc. 1420 River Park Dr Ste 120 Sacramento CA 95815-4506 Ph: (800) 991-6147 |
| NPI Number | 1679117972 |
|---|---|
| Provider Enumeration Date | 10/30/2019 |
| Last Update Date | 07/23/2024 |
| Medicare PECOS PAC ID | 2466881883 |
|---|---|
| Medicare Enrollment ID | O20200407001296 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679117972 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
| Provider Name | Venu M Kondle |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1023025863 PECOS PAC ID: 3072584457 Enrollment ID: I20040802001443 |
| Provider Name | Holly J Chandler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205067899 PECOS PAC ID: 4082929716 Enrollment ID: I20150810002872 |
| Provider Name | Chirag Amin |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1760723035 PECOS PAC ID: 9537438023 Enrollment ID: I20170626002232 |
| Provider Name | Heather Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447769286 PECOS PAC ID: 2961760426 Enrollment ID: I20171211002683 |
| Provider Name | Kathleen Camia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306168752 PECOS PAC ID: 9830440106 Enrollment ID: I20190201002027 |
| Provider Name | Thomas Patrick Anker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871948521 PECOS PAC ID: 2365876778 Enrollment ID: I20191217003353 |
| Provider Name | Alyssa Virginia Johnston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891281432 PECOS PAC ID: 6709213069 Enrollment ID: I20200625000751 |
| Provider Name | Sharon Munyaanyi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750844767 PECOS PAC ID: 2860802717 Enrollment ID: I20201103002860 |
| Provider Name | Ma. Lendy Sumaylo-ortiguesa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649810227 PECOS PAC ID: 2466867114 Enrollment ID: I20210427002812 |
| Provider Name | Sachin Anujeet Singh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700478211 PECOS PAC ID: 5092110338 Enrollment ID: I20210824002638 |
| Provider Name | Yanxia Li |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558880062 PECOS PAC ID: 4880091875 Enrollment ID: I20210917000393 |
| Provider Name | Joann Strang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760698575 PECOS PAC ID: 1658765847 Enrollment ID: I20220304000646 |
| Provider Name | Glenda A Agustin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043606130 PECOS PAC ID: 5991056772 Enrollment ID: I20220322000987 |
| Provider Name | Milka Njeri Mbugua |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437705662 PECOS PAC ID: 0840686606 Enrollment ID: I20220404000457 |
| Provider Name | Yvonne Mun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306323118 PECOS PAC ID: 2163776097 Enrollment ID: I20230213000527 |
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