NPIMap

Organization Active NPI

Circle of Life Medicine, Inc

  • Family Medicine Physician
  • Elk Grove, CA
National Provider Identifier
1306083118
Registry record updated Jan 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A608670 Issued in CA
Legal business name
CIRCLE OF LIFE MEDICINE, INC
Practice address
2382 Maritime Dr
#100
Elk Grove, CA 95758-3639
Phone
(916) 691-6622
Fax
(916) 691-6629
NPI assigned
Jan 15, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2009

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

Authorized official

Name
Jeannette I Frei, M.D.
Title
Owner
Phone
(916) 691-6622

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X A608670 CA Primary

Addresses

Primary practice location

2382 Maritime Dr
#100
Elk Grove, CA 95758-3639

Mailing address

2382 Maritime Dr
#100
Elk Grove, CA 95758-3639
Phone (916) 691-6622

Other identifiers 1

IdentifierTypeStateIssuer
00A608670MedicaidCA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1231977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231977600000",
    "number": "1306083118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2382 MARITIME DR",
            "address_2": "#100",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957583639",
            "telephone_number": "916-691-6622",
            "fax_number": "916-691-6629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2382 MARITIME DR",
            "address_2": "#100",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957583639",
            "telephone_number": "916-691-6622",
            "fax_number": "916-691-6629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIRCLE OF LIFE MEDICINE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-15",
        "last_updated": "2009-01-15",
        "status": "A",
        "authorized_official_last_name": "FREI",
        "authorized_official_first_name": "JEANNETTE",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-691-6622",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A608670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A608670",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2009; 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.