Individual provider Active NPI

Clifford Marr, MD

  • Pediatric Surgery Physician
  • Sacramento, CA
National Provider Identifier
1215929799
Registry record updated Jan 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
G45773 Issued in CA
Practice address
5275 F St
Ste 3
Sacramento, CA 95819-3225
Phone
(916) 733-6050
Fax
(916) 733-6051
NPI assigned
Aug 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X G45773 CA Primary

Addresses

Primary practice location

5275 F St
Ste 3
Sacramento, CA 95819-3225

Mailing address

P.O. Box 255228
Sacramento, CA 95865-5228
Phone (800) 470-0071

Other identifiers 1

IdentifierTypeStateIssuer
00G457730MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G45773CAMDPediatric Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Perinatal & Pediatric Specialists Medical Group Inc. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326326400000",
    "number": "1215929799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 255228",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958655228",
            "telephone_number": "800-470-0071",
            "fax_number": "916-736-6798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5275 F ST",
            "address_2": "STE 3",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958193225",
            "telephone_number": "916-733-6050",
            "fax_number": "916-733-6051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARR",
        "first_name": "CLIFFORD",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2012-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "CA",
            "license": "G45773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G457730",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.