TEODORO P. NISSEN M.D., INC
NPI 1629248109
Specialist in Vallejo, CA
NPI Status: Active since March 11, 2008
Contact Information
1460 N CAMINO ALTO STE 201
VALLEJO, CA
ZIP 94589
Phone: (707) 645-7210
Fax: (707) 645-7249
- Organization
- Specialist
- Accepts Insurance
- CLIA Number: 05D2007926
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 08-17-2026
About TEODORO P. NISSEN M.D., INC
This page provides the complete NPI Profile along with additional information for Teodoro P. Nissen M.d., Inc, a provider established in Vallejo, California operating as a Specialist. The healthcare provider is registered in the NPI registry with number 1629248109 assigned on March 2008. The practitioner's primary taxonomy code is 174400000X with license number A77901 (CA). The provider is registered as an organization and their NPI record was last updated February 2026. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The provider's
- NPI
- 1629248109
- Provider Legal Name
- TEODORO P. NISSEN M.D., INC
- Other Organization Name
- Other Name Type
- (6)
- Entity Type
- Organization
- Location Address
- 1460 N CAMINO ALTO STE 201 VALLEJO, CA 94589
- Location Phone
- (707) 645-7210
- Location Fax
- (707) 645-7249
- Mailing Address
- 1460 N CAMINO ALTO STE 201 VALLEJO, CA 94589
- Mailing Phone
- (707) 645-7210
- Mailing Fax
- (707) 645-7249
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-11-2008
- Last Update Date
- 02-12-2026
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Specialist
- Taxonomy Code
- 174400000X
- Type
- Other Service Providers
- License No.
- A77901
- License State
- CA
- Taxonomy Description
- An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue KC Catastrophic BlueSelect EPO - EPO
- Blue KC Choice Bronze 2 with Spira Care BlueSelect EPO - EPO
- Blue KC Choice Silver 1 with Spira Care BlueSelect EPO - EPO
- Blue KC Community Silver Preferred-Care Blue EPO - EPO
- Blue KC First Bronze Preferred-Care Blue EPO - EPO
- Blue KC Simply Blue Bronze with Spira Care Blue Metro EPO - EPO
- Blue KC Simply Blue Gold with Spira Care Blue Metro EPO - EPO
- Blue KC Simply Blue Silver with Spira Care Blue Metro EPO - EPO
- Blue KC Standard Bronze BlueSelect EPO - EPO
- Blue KC Standard Bronze Preferred-Care Blue EPO - EPO
- Blue KC Standard Gold BlueSelect EPO - EPO
- Blue KC Standard Gold Preferred-Care Blue EPO - EPO
- Blue KC Standard Silver BlueSelect EPO - EPO
- Blue KC Standard Silver Preferred-Care Blue EPO - EPO
- Select by Medica Bronze $0 Copay PCP Visits - EPO
- Select by Medica Bronze Share - EPO
- Select by Medica Expanded Bronze Standard - EPO
- Select by Medica Gold $0 Copay PCP Visits - EPO
- Select by Medica Gold Share - EPO
- Select by Medica Gold Standard - EPO
- Select by Medica Silver $0 Copay PCP Visits - EPO
- Select by Medica Silver Share - EPO
- Select by Medica Silver Standard - EPO
- Sanford Individual Simplicity $1,750 - PPO
- Sanford Individual Simplicity $10,600 - PPO
- Sanford Individual Simplicity $3,500 - PPO
- Sanford Individual Simplicity $4,750 - PPO
- Sanford Individual Simplicity $6,500 - PPO
- Sanford Individual Simplicity $7,200 HSA Qualified - PPO
- Sanford Individual Simplicity Standardized $2,000 - PPO
- Sanford Individual Simplicity Standardized $6,000 - PPO
- Sanford Individual Simplicity Standardized $7,500 - PPO
- Sanford Individual TRUE $1,750 - HMO
- Sanford Individual TRUE $10,600 - HMO
- Sanford Individual TRUE $3,500 - HMO
- Sanford Individual TRUE $4,750 - HMO
- Sanford Individual TRUE $6,500 - HMO
- Sanford Individual TRUE $7,200 HSA Qualified - HMO
- Sanford Individual TRUE Standardized $2,000 - HMO
- Sanford Individual TRUE Standardized $6,000 - HMO
- Sanford Individual TRUE Standardized $7,500 - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 05D2007926
- Facility Type
- Physician Office
- Certificate Effective Date
- August 18, 2024
- Certificate Expiration Date
- August 17, 2026
- Laboratory Director
- TEODORO P. NISSEN
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Teodoro P. Nissen M.d., Inc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
Reviews for TEODORO P. NISSEN M.D., INC
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1629248109, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 61. The final step is to find the difference between that total and the next multiple of ten (70 - 61 = 9).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 61 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1629248109, enumerated as an "organization" on March 11, 2008.
The provider is located at 1460 N CAMINO ALTO STE 201 VALLEJO, CA 94589 and the phone number is (707) 645-7210.
Specialist with taxonomy code 174400000X.
The provider might be accepting Accepts: Blue Cross and Blue Shield of Kansas City, Medica. Please consult your insurance carrier or call the provider to verify.
