Dignity Health Medical Foundation

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

DIGNITY HEALTH MEDICAL FOUNDATION

Doing business as

Mercy Medical Group, a service of Dignity Health Medical Foundation

Practice address

1700 Prairie City Rd
Folsom, CA 95630-9594

Phone

(916) 351-4800

Fax

(916) 351-4899

NPI assigned

Mar 16, 2007

Organization subpart

Yes

Parent organization

DIGNITY HEALTH MEDICAL FOUNDATIONAs reported in NPPES

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

Authorized official

Name

Theresa M Hylen

Title

Chief Financial Officer

Phone

(916) 851-2559

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Mercy Medical Group, a service of Dignity Health Medical Foundation Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

CLIA laboratory certificates

Part of

Woodland Clinic Med GRP

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1497879597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60000",
            "address_2": "FILE #72938",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941602938",
            "telephone_number": "916-733-3397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 PRAIRIE CITY RD",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956309594",
            "telephone_number": "916-351-4800",
            "fax_number": "916-351-4899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGNITY HEALTH MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIGNITY HEALTH MEDICAL FOUNDATION",
        "enumeration_date": "2007-03-16",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "HYLEN",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "916-851-2559"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "983",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "195",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECIAL PURPOSE TAX ID #",
            "identifier": "341996544",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0091673",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1BY",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0019838",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA",
            "identifier": "ZZZ13173Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Medical Group, a service of Dignity Health Medical Foundation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Medical Group, a service of Dignity Health Medical Foundation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Crystal Diei
• Juliana Diemert
• Cheryl Lynn Dietrick, DC
• Brian Dietz, DPT
• Dignity Health
• Dignity Health Medical Foundation
• Shannon Suzanne Dillon, MD
• Shaina M Dimariano, D.D.S.
• Cecilia Romo Divin, M.D.
• Scarlett Anne-Marie Dizon

• Multi-Specialty Clinic/Center in Folsom, CA
• Providers in Folsom, CA by specialty
• Multi-Specialty Clinic/Center in California

• 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 enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.