Individual provider Active NPI

Carolyn Ashley Eggert, NP

  • Family Nurse Practitioner
  • Lincoln, CA
National Provider Identifier
1336766898
Registry record updated Jan 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95019421 Issued in CA
Practice address
77 Lincoln Blvd Ste 1
Lincoln, CA 95648-7422
Phone
(916) 340-8587
NPI assigned
Jul 1, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95019421 CA Primary

Addresses

Primary practice location

77 Lincoln Blvd Ste 1
Lincoln, CA 95648-7422

Mailing address

77 Lincoln Blvd Ste 1
Lincoln, CA 95648-7422
Phone (916) 258-2751

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230317002639 CA Practitioner - Nurse Practitioner 6406220235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eric L Ellis MD IncGroup PAC ID 9032458815, 17 clinicians

Practice addresses (Care Compare)

5290 Douglas Blvd
Granite Bay, CA 95746-6205
Phone (916) 258-2751

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95019421CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Eric L Ellis MD Inc CurrentSince Jan 1, 2023 Accepting new patients
Sutter North Medical Foundation Past Accepting new patients

Locations

5290 Douglas Blvd
Ste 102
Granite Bay, CA 95746

5290 Douglas Blvd
Granite Bay, CA 95746
Phone (916) 258-2751

77 Lincoln Blvd
Ste 1
Lincoln, CA 95648
Phone (916) 258-2751

Interoperability endpoints

  • Direct secure messaging: carolyn.eggert.1@19336.direct.athenahealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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": "1593561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641340800000",
    "number": "1336766898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 LINCOLN BLVD STE 1",
            "city": "LINCOLN",
            "state": "CA",
            "postal_code": "956487422",
            "telephone_number": "916-258-2751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 LINCOLN BLVD STE 1",
            "city": "LINCOLN",
            "state": "CA",
            "postal_code": "956487422",
            "telephone_number": "916-340-8587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGGERT",
        "first_name": "CAROLYN",
        "middle_name": "ASHLEY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-01",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95019421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, CA

Sources for this page

Verify at the official NPI Registry.