ROSEVILLE PEDIATRIC MEDICAL GROUP, INC
NPI 1275647737
Clinic/Center - Primary Care in Roseville, CA

Q: What is Roseville Pediatric Medical Group, Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Active since August 19, 2006CLIA 05D0970606 · Waiver

1098 SUNRISE AVE STE 100, ROSEVILLE, CA 95661(916) 789-1798(916) 789-0889 Get Directions Write a Review

NPPES record last updated: September 17, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Roseville Pediatric Medical Group, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ROSEVILLE PEDIATRIC MEDICAL GROUP, INC (NPI 1275647737) is a healthcare organization registered as a primary care in Roseville, California and active in the NPI registry since August 2006. The organization holds a CLIA Waiver certificate valid through February 17, 2028 and lists Jennell Mae Serda, Manager, as its authorized official.

NPPES Registry Identity

NPI1275647737

Entity TypeOrganization

Primary Taxonomy261QP2300X

Legal Business NameROSEVILLE PEDIATRIC MEDICAL GROUP, INC

Location Address1098 SUNRISE AVE STE 100Roseville, CA 95661-4469

Mailing Address1098 Sunrise Ave Ste 100Roseville, CA 95661-4469 · (916) 789-1798 · Fax (916) 789-0889

Phone(916) 789-1798

Fax(916) 789-0889

Organization SubpartNo

Authorized OfficialJennell Mae SerdaManager · (916) 789-1798

Enumeration DateAugust 19, 2006

Last NPPES UpdateSeptember 17, 2008

✔ NPI 1275647737 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities

Taxonomy Code261QP2300X

License✔ Licensed in CA · 029336

1098 SUNRISE AVE STE 100, Roseville, CA 95661

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Other Identifiers 2

Medicare UPIN33843ZZCA

Medicare UPIN2146331CA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0970606

Pediatric Medical Associates Dba Roseville Pediatric Medical Grp · Roseville, CA

Active · expires Feb 17, 2028

CLIA Number05D0970606

Laboratory TypePhysician Office

Certificate Effective DateFebruary 18, 2026

Certificate Expiration DateFebruary 17, 2028

Laboratory DirectorRavinder S. Khaira, MD

Laboratory Phone(916) 789-1798

Laboratory LocationPediatric Medical Associates Dba Roseville Pediatric Medical Grp902 Cirby Way, Roseville, CA 95661

CLIA data matches this NPI record on: Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROSEVILLE MD INC.

Family Medicine

1098 SUNRISE AVE STE 100
ROSEVILLE, CA 95661

Placer County (916) 791-7285

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Roseville Pediatric Medical Group, Inc's NPI number?

The NPI number for Roseville Pediatric Medical Group, Inc is 1275647737. It was assigned to this organization in the NPPES registry on August 19, 2006.

Where is Roseville Pediatric Medical Group, Inc located?

Roseville Pediatric Medical Group, Inc is located at 1098 Sunrise Ave Ste 100, Roseville, CA 95661. The listed phone number is (916) 789-1798.

What is Roseville Pediatric Medical Group, Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Roseville Pediatric Medical Group, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0970606) is associated with this NPI, valid through February 17, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Roseville Pediatric Medical Group, Inc was last updated on September 17, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.