CANCER THERAPY MEDICAL GROUP INC (NPI# 1508876400) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508876400 |
| Entity Type | Organization |
| Organization Name | CANCER THERAPY MEDICAL GROUP INC |
| Other Organization Name | SOUTH SACRAMENTO CANCER CENTER |
| Practice Address |
8100 Bruceville Rd Sacramento CA 95823-2353 |
| Mailing Address |
Po Box 756 Danville CA 94526-0756 |
| Practice Telephone | 9166839616 |
| Practice Fax Number | 9166881320 |
| Mailing Telephone | 2095430684 |
| Mailing Fax Number | 2093433809 |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2009-08-25 |
| Authorized Official Name | DOUG MCBRIDE (ADMINISTRATOR) |
| Authorized Official Telephone | 9258207101 |
| Is Organization Subpart | Y |
| Parent Organization Name | CANCER THERAPY MEDICAL GROUP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BLUE SHIELD | ZZZ50269Z | 01 | |
| RAILROAD MEDICARE | DC7191 | 01 | |
| CA | GR0092412 | 05 |
| Other Name | Type Code |
|---|---|
| South Sacramento Cancer Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952585754 | Cancer Therapy Medical Group Inc | Radiology | 1445 Livorna Rd, Alamo, CA 94507-1103 | 2007-12-28 |
| 1649280520 | Cancer Therapy Medical Group Inc | Radiology | 301 Professional Center Dr, Rohnert Park, CA 94928-2152 | 2006-08-09 |
| 1659381549 | Cancer Therapy Medical Group Inc | Radiology | 7887 N Cedar Ave, Fresno, CA 93720-2685 | 2006-08-09 |
| Street Address |
8100 BRUCEVILLE RD |
| City | SACRAMENTO |
| State | CA |
| Zip Code | 95823-2353 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235148495 | Vincent John Lee | Radiology | 8100 Bruceville Rd, Sacramento, CA 95823-2353 | 2006-08-05 |
| 1619233582 | Capital Advanced Surgery A Professional Corporation | Surgery | 8100 Bruceville Rd, Sacramento, CA 95823-2353 | 2012-04-05 |
| 1811132152 | Paul Noble Page | Radiology | 8100 Bruceville Rd, Sacramento, CA 95823 | 2008-12-15 |
| 1316064546 | Wen Long | Surgery | 8100 Bruceville Rd, Sacramento, CA 95823-2353 | 2007-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396343422 | Renee Yvonne Friesner | Registered Nurse | 6965 65th Street, Sacramento, CA 95823 | 2020-10-12 |
| 1790392165 | Amanda Moore | Technician | 6445 Village Center Dr, Building 7 Apt 101, Sacramento, CA 95823 | 2020-09-29 |
| 1114562766 | Daniel & Max, LLC | Optometrist | 4200 Florin Road, Suite C, Florin, CA 95823 | 2019-11-07 |
| 1396393823 | Lannon Hope Gustafson | Counselor | 8573 E Southgate Dr., Sacramento, CA 95823 | 2019-08-28 |
| 1932768280 | Sprenger Behavioral Medicine, Inc | Psychiatry & Neurology | 7601 Hospital Drive Suite 202, Suite 202, Sacramento, CA 95823 | 2019-06-11 |
| 1306316880 | Evin Johnson | Case Manager/Care Coordinator | 7000 Franklin Blvd Suite 625, Sacramento, CA 95823 | 2018-11-28 |
| 1902373095 | Alexandra L Bourcy | Family Medicine | 7275 E Southgate Dr Ste 204-206, Sacramento, CA 95823 | 2018-10-27 |
| 1891298923 | Nicholas Joseph Henderson | Behavior Technician | 6500 47th Street Apt#76, Sacramento, CA 95823 | 2018-03-15 |
| 1427567098 | Luz Maria Udave | Behavior Technician | 5435 Mack Rd Apt 87, Sacramento, CA 95823 | 2017-09-26 |
| 1417474743 | Elizabeth Smithers | Behavior Technician | 5545 Sky Parkway #202, Sacramento, CA 95823 | 2017-08-28 |
| Find all providers in zip 95823 | ||||
| Taxonomy Code | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619136835 | Arta Monir Monjazeb | Radiology | 4501 X Street, G120, Uc Davis Health System Department of Radiation Oncology, Sacramento, CA 95817-0000 | 2008-06-03 |
| 1780863340 | Megan Eileen Daly | Radiology | 4501 X St # G140, Department of Radiation Oncology, Sacramento, CA 95817-2229 | 2007-10-31 |
| 1235148495 | Vincent John Lee | Radiology | 8100 Bruceville Rd, Sacramento, CA 95823-2353 | 2006-08-05 |
| 1235152232 | Richard K. Valicenti | Radiology | 4501 X Street, Ground Floor, Sacramento, CA 95817-2229 | 2006-07-25 |
| 1457334534 | Tony S Quang | Radiology | 4501 X St Ste 0140, Sacramento, CA 95817-2229 | 2005-11-22 |
| 1164420808 | Harvey Brian Wolkov | Radiology | 2800 L St, Sacramento, CA 95816-5616 | 2005-07-07 |
| 1952308041 | Garrick Chi-rey Chang | Radiology | 2801 K St Ste 502, Sacramento, CA 95816-5119 | 2005-07-05 |
| 1669479853 | Mark David Logsdon | Radiology | 2825 Capitol Ave Ste 502, Sacramento, CA 95816 | 2005-07-01 |
| 1710983358 | Susan Weishenn Lee | Radiology | 4001 J St, Sacramento, CA 95819-3626 | 2005-06-27 |
| 1285011254 | Ky Nam Bao Nguyen | Radiology | 4501 X St, G140, Sacramento, CA 95817-2229 | 2015-04-29 |
| Find all providers in SACRAMENTO | ||||
| City | SACRAMENTO |
| Zip Code | 95823 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.