Active NPI
Robert Hadley Hargrove, M.D.
- Dermatology Physician
- Roseville, CA
National Provider Identifier
1114940343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- G46499
- Practice address
- 10 Sierra Gate PLZ Ste 120
Roseville, CA 95678-6647 - Phone
- (916) 784-1155
- Fax
- (916) 773-0995
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | G46499 | CA | Primary |
Addresses
Primary practice location
10 Sierra Gate PLZ Ste 120
Roseville, CA 95678-6647
Mailing address
10 Sierra Gate PLZ Ste 120
Roseville, CA 95678-6647
Phone (916) 784-1155
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 680021148 | Other | CO | BLUE SHIELD |
| 00G464990 | Medicaid | CA | |
| 680021148 | Other | CA | BLUE CROSS |
| 680021148 | Other | CA | UNITED HEALTHCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041117001202 | CA | Practitioner - Dermatology | 7315901477 | Practice locations: Roseville, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G46499 | CA | MD | Dermatology Physician |
Interoperability endpoints
- rhargrovemd31186@hisp.ehr.sutterhealth.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114940343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 SIERRA GATE PLZ STE 120",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956786647",
"telephone_number": "916-784-1155",
"fax_number": "916-773-0995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 SIERRA GATE PLZ STE 120",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956786647",
"telephone_number": "916-784-1155",
"fax_number": "916-773-0995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARGROVE",
"first_name": "ROBERT",
"middle_name": "HADLEY",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "CA",
"license": "G46499",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "680021148",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G464990",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "680021148",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "680021148",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roseville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.