MEDICARE: NORTHERN CALIFORNIA CARDIOLOGY ASSOCIATES MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0001X	Clinical Cardiac Electrophysiology Physician	207RC0001X	CA
2	207RI0011X	Interventional Cardiology Physician	207R10011X	CA
3	207UN0901X	Nuclear Cardiology Physician	207UN0901X	CA
4	207RC0000X	Cardiovascular Disease Physician	207RC0000X	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DA7085	OTHER	CA	RAILROAD MEDICARE PIN
12	DB9095	OTHER	CA	RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ZZZ075232	OTHER	CA	BLUE SHIELD OF CA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	ZZZ07524Z	OTHER	CA	BLUE SHIELD OF CA
6	ZZZ07522Z	OTHER	CA	BLUE SHIELD OF CA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	ZZZ08053Z	OTHER	CA	BLUE SHIELD OF CA
11	ZZZ66346Z	OTHER	CA	BLUE SHIELD OF CA

General Provider Information

NPI Number	:	1467444711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN CALIFORNIA CARDIOLOGY ASSOCIATES MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	1330 21ST STREET #201
Second Line	:	C/O MIDTOWN FINANCIAL
City	:	SACRAMENTO
State	:	CA
Zip	:	95811-4231
Country	:	US
Telephone Number	:	916-561-6848
Fax Number	:	916-447-9210

Provider Business Practice Location Address
First Line	:	5301 F ST
Second Line	:	#117
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3226
Country	:	US
Telephone Number	:	916-733-1788
Fax Number	:	916-733-1787

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM R. VETTER
Credential	:	M.D.
Telephone Number	:	916-733-1788

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	10/20/2009

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