NPIMap

Organization Active NPI

Dignity Health

Doing business as Mercy Medical Center Mt. Shasta Physicians

  • Rural Health Clinic/Center
  • Mount Shasta, CA
National Provider Identifier
1508341397
Registry record updated Sep 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DIGNITY HEALTH
Doing business as
Mercy Medical Center Mt. Shasta Physicians
Practice address
912 Pine St
Mount Shasta, CA 96067-2143
Phone
(530) 926-7196
NPI assigned
Sep 27, 2018
Last updated
Sep 27, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
DIGNITY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 27, 2018

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

Authorized official

Name
Kim Miranda
Title
Chief Financial Officer
Phone
(530) 225-6121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

912 Pine St
Mount Shasta, CA 96067-2143

Mailing address

3400 Data Dr
Rancho Cordova, CA 95670-7956
Phone (916) 379-2782

Other names 1

  • Mercy Medical Center Mt. Shasta Physicians Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081223000427 CA Part B Supplier - Clinic/Group Practice 2062320559 Receives reassigned benefits from 130 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mount Shasta, CA; Red Bluff, CA; Redding, CA

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Mercy Medical Ctr

Locations

2620 Edith Ave
Redding, CA 96001
Phone (530) 229-0360

Practitioners & affiliated clinicians

Practitioners 46

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.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1538006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538006400000",
    "number": "1508341397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707956",
            "telephone_number": "916-379-2782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 PINE ST",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "960672143",
            "telephone_number": "530-926-7196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGNITY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIGNITY HEALTH",
        "enumeration_date": "2018-09-27",
        "last_updated": "2018-09-27",
        "status": "A",
        "authorized_official_last_name": "MIRANDA",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "530-225-6121"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Medical Center Mt. Shasta Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Shasta, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.