NPIMap

Organization Active NPI

Dignity Health Medical Foundation

Doing business as Dignity Health Medical Foundation - El Dorado Hills

  • Non-Pharmacy Dispensing Site
  • El Dorado Hills, CA
National Provider Identifier
1497180632
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
A96435 Issued in CA
Legal business name
DIGNITY HEALTH MEDICAL FOUNDATION
Doing business as
Dignity Health Medical Foundation - El Dorado Hills
Practice address
1264 Hawks Flight CT
Suite 100
El Dorado Hills, CA 95762-9348
Phone
(916) 939-8400
NPI assigned
Sep 6, 2013
Last updated
Nov 18, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

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

Authorized official

Name
Kenny Heine
Title
VP of Operations
Phone
(858) 964-1506

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X A96435 CA Primary

Addresses

Primary practice location

1264 Hawks Flight CT
Suite 100
El Dorado Hills, CA 95762-9348

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

Other names 1

  • Dignity Health Medical Foundation - El Dorado Hills Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2065999Dignity Health Medical Foundation1264 Hawks Flight Court, Suite 100, El Dorado Hills, CA 95762Provider-performed microscopyMar 23, 2028

National Provider Directory

National Provider Directory
Tax ID family
Woodland Clinic Med GRP15 organizations share this tax ID, including this one
Part of
Medvantx Inc

Other organizations with this tax ID 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1378425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1497180632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1264 HAWKS FLIGHT CT",
            "address_2": "SUITE 100",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957629348",
            "telephone_number": "916-939-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGNITY HEALTH MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2013-09-06",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "A96435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dignity Health Medical Foundation - El Dorado Hills",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dignity Health Medical Foundation - El Dorado Hills",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Dorado Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.