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Individual provider Active NPI

Ethelwoldo Pascual Guerrero, MD

  • Internal Medicine Physician
  • Colusa, CA
National Provider Identifier
1235155318
Registry record updated Sep 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A61539 Issued in CA
Practice address
151 E Webster St
Colusa, CA 95932-2949
Phone
(530) 458-4250
NPI assigned
Jul 14, 2006
Last updated
Sep 23, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A61539 CA Primary

Addresses

Primary practice location

151 E Webster St
Colusa, CA 95932-2949

Mailing address

550 W Ranch View Dr
Rocklin, CA 95765-5396
Phone (916) 295-5700

Other identifiers 1

IdentifierTypeStateIssuer
00A6153900MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050930000426 CA Practitioner - Internal Medicine 2163457821 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3160 Folsom Blvd
Suite 2500
Sacramento, CA 95816-5267
Phone (916) 734-7777

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions25
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
61539CAMDDentist
A61539CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California Current Accepting new patients
Regents of the University of California CurrentSince Nov 1, 2009 Accepting new patients
Regents of the University of Ca CurrentSince Nov 1, 2009 Accepting new patients
Regents of the University of Ca Past Accepting new patients
Essent PRMC LP Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Regents of the University of California Past Accepting new patients

Locations

550 W Ranch View Dr
Rocklin, CA 95765
Phone (916) 295-5700

550 W Ranch View Dr
Ste 2005
Rocklin, CA 95765
Phone (916) 295-5700

3160 Folsom Blvd
Ste 2500
Sacramento, CA 95816
Phone (916) 734-5846

4860 Y St
Ste 200
Sacramento, CA 95817
Phone (916) 734-3761

4900 Broadway
Ste 1200
Sacramento, CA 95820
Phone (916) 734-9255

500 University Ave
Ste 220
Sacramento, CA 95825
Phone (916) 286-8700

Organizations & group practices 8

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

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316736000000",
    "number": "1235155318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 W RANCH VIEW DR",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "957655396",
            "telephone_number": "916-295-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 E WEBSTER ST",
            "city": "COLUSA",
            "state": "CA",
            "postal_code": "959322949",
            "telephone_number": "530-458-4250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUERRERO",
        "first_name": "ETHELWOLDO",
        "middle_name": "PASCUAL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2011-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A61539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A6153900",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colusa, CA

Sources for this page

Verify at the official NPI Registry.