NPIMap

Organization Active NPI

CHW Medical Foundation

Doing business as Mercy Medical Group, a Service of CHW Medical Foundation

  • Multi-Specialty Clinic/Center
  • Cameron Park, CA
National Provider Identifier
1508096132
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
CHW MEDICAL FOUNDATION
Doing business as
Mercy Medical Group, a Service of CHW Medical Foundation
Practice address
3581 Palmer Dr
Suite 402
Cameron Park, CA 95682-8236
Phone
(530) 676-7337
Fax
(530) 676-1141
NPI assigned
Jul 16, 2009
Last updated
Nov 18, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CHW MEDICAL FOUNDATIONAs 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
Theresa M Hylen
Title
Chief Financial Officer
Phone
(916) 851-2559

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

3581 Palmer Dr
Suite 402
Cameron Park, CA 95682-8236

Mailing address

3000 Q St
Sacramento, CA 95816-7058
Phone (916) 733-5701

Other names 1

  • Mercy Medical Group, a Service of CHW Medical Foundation Doing business as

National Provider Directory

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

Other organizations with this tax ID 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1247702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1508096132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 Q ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958167058",
            "telephone_number": "916-733-5701",
            "fax_number": "916-859-1671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3581 PALMER DR",
            "address_2": "SUITE 402",
            "city": "CAMERON PARK",
            "state": "CA",
            "postal_code": "956828236",
            "telephone_number": "530-676-7337",
            "fax_number": "530-676-1141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHW MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHW MEDICAL FOUNDATION",
        "enumeration_date": "2009-07-16",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Medical Group, a Service of CHW Medical Foundation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Medical Group, a Service of CHW Medical Foundation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cameron Park, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.