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

7911 Laguna Blvd
Elk Grove, CA 95758-7920

Phone

(916) 733-5801

Fax

(916) 683-0232

NPI assigned

Mar 15, 2007

Last updated

Nov 18, 2020By the provider in NPPES

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

Part of

Woodland Clinic Med GRP

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1558495937",
    "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": "7911 LAGUNA BLVD",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957587920",
            "telephone_number": "916-733-5801",
            "fax_number": "916-683-0232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGNITY HEALTH MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIGNITY HEALTH MEDICAL FOUNDATION",
        "enumeration_date": "2007-03-15",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "983",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ09972Z",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "KYZ",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0019838",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR006356B",
            "state": "CA"
        }
    ],
    "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"
        }
    ]
}

• Ramona Dickson, MFT INTERN
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• Diem T. Nguyen, DC a Profession Chiropractic Corporation
• Chris Dige
• Consuelo Maria Dinh, LVN
• Jacqueline Dinis
• Fred P Dinitz, DDS INC
• O'Bryan M Dixon
• Victoria Banez Dizon, M.D.

• Multi-Specialty Clinic/Center in Elk Grove, CA
• Providers in Elk Grove, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.