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VICKY V BOURDANIOTIS RD
NPI 1417237298
Dietitian, Registered in Roseville, CA

Active since August 24, 2011
3100 DOUGLAS BLVD, ROSEVILLE, CA 95661(916) 774-8885(916) 774-8818 Get Directions Write a Review

NPPES record last updated: August 24, 2011. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Vicky V Bourdaniotis Rd NPPES

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

VICKY V BOURDANIOTIS RD (NPI 1417237298) is an individual dietitian, registered in Roseville, California, licensed in California (1045819) and active in the NPI registry since August 2011.

NPPES Registry Identity

NPI1417237298
Entity TypeIndividualFemale
Primary Taxonomy133V00000X
Provider Legal NameVICKY V BOURDANIOTISCredential: RD
Location Address3100 DOUGLAS BLVDRoseville, CA 95661-3866
Mailing AddressPo Box 255228Sacramento, CA 95865-5228 · (800) 470-0071
Phone(916) 774-8885
Fax(916) 774-8818
Sole ProprietorNo
Enumeration DateAugust 24, 2011
✔ NPI 1417237298 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers
Taxonomy Code133V00000X
License✔ Licensed in CA · 1045819
Definition
A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.
3100 DOUGLAS BLVD, Roseville, CA 95661
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Vicky V Bourdaniotis Rd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

Medicare enrollment records show Vicky Bourdaniotis reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Sutter Medical Foundation
13 mi
Diagnostic Radiology
2800 L ST FL 7
Sacramento, CA 95816
  • Reassigned Medicare billing, California enrollment
  • Medicare enrollment name: Sutter Valley Medical Foundation
  • 3,056 clinicians in this Medicare group
NPI 1942524095 (916) 731-7857

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

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

JENINA SEGALE RD
Dietitian, Registered
3100 DOUGLAS BLVD
ROSEVILLE, CA 95661
Placer County (916) 774-8885
ANN MARIE WINTERTON LCSW
Dietitian, Registered
3100 DOUGLAS BLVD, SUITE 204
ROSEVILLE, CA 95661
Placer County (916) 774-8885
MARIA-DOLORES CERQUEIRA HANEFFANT PA
Physician Assistant (Medical)
3100 DOUGLAS BLVD
ROSEVILLE, CA 95661
Placer County (916) 774-8300
RUPINDER TUMBER RD
Dietitian, Registered
3100 DOUGLAS BLVD
ROSEVILLE, CA 95661
Placer County (916) 774-8885
MRS. GINA M WHITELEY I RD, CDE
Dietitian, Registered
3100 DOUGLAS BLVD
ROSEVILLE, CA 95661
Placer County (916) 865-1140
DR. KENNY BAINS M.D.
Family Medicine
3100 DOUGLAS BLVD
ROSEVILLE, CA 95661
Placer County (916) 774-8300
PATRICIA MARIE DIXSON FNP
Nurse Practitioner (Family)
3100 DOUGLAS BLVD, SUITE 325
ROSEVILLE, CA 95661
Placer County (916) 241-9844
DR. ROGER ANG M.D.
Family Medicine
3100 DOUGLAS BLVD
ROSEVILLE, CA 95661
Placer County (916) 774-8300

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 Vicky Bourdaniotis's NPI number?

The NPI number for Vicky Bourdaniotis is 1417237298. It was assigned to this individual provider in the NPPES registry on August 24, 2011.

Where is Vicky Bourdaniotis located?

Vicky Bourdaniotis practices at 3100 Douglas Blvd, Roseville, CA 95661. The listed phone number is (916) 774-8885.

What is Vicky Bourdaniotis's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Is Vicky Bourdaniotis enrolled in Medicare?

Yes. Vicky Bourdaniotis is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Vicky Bourdaniotis's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Vicky Bourdaniotis reassigns Medicare benefits to Sutter Medical Foundation (Sacramento, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Vicky Bourdaniotis's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Vicky Bourdaniotis was last updated on August 24, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.