NPIMap

Organization Active NPI

Supplemental Health Care

  • Exclusive Provider Organization
  • Placerville, CA
National Provider Identifier
1306121801
Registry record updated Oct 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Exclusive Provider OrganizationTaxonomy code 302F00000X
License
9135 Issued in CA
Legal business name
SUPPLEMENTAL HEALTH CARE
Practice address
2515 Augustine LN
Placerville, CA 95667
Phone
(530) 409-7103
NPI assigned
Oct 15, 2011
Last updated
Oct 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2011

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

Authorized official

Name
Mr. Brian Stahl, PHYSICAL THERAPIST
Title
Physical Therapist
Phone
(530) 409-7103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X 9135 CA Primary

Addresses

Primary practice location

2515 Augustine LN
Placerville, CA 95667

Mailing address

2515 Augustine LN
Placerville, CA 95667-7120
Phone (530) 409-7103

National Provider Directory

National Provider Directory
Tax ID family
Supplemental Healthcare42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1318636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318636800000",
    "number": "1306121801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2515 AUGUSTINE LN",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956677120",
            "telephone_number": "530-409-7103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 AUGUSTINE LN",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "95667",
            "telephone_number": "530-409-7103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPLEMENTAL HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-15",
        "last_updated": "2011-10-15",
        "status": "A",
        "authorized_official_last_name": "STAHL",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "530-409-7103",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHYSICAL THERAPIST"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "CA",
            "license": "9135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Placerville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2011; 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.