NPIMap

Organization Active NPI

Shasta Regional Medical Group, Inc

  • Family Medicine Physician
  • Weed, CA
National Provider Identifier
1588048680
Registry record updated Aug 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SHASTA REGIONAL MEDICAL GROUP, INC
Practice address
50 Alamo Ave
Weed, CA 96094-2352
Phone
(530) 605-4263
NPI assigned
Jul 17, 2015
Last updated
Aug 11, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
SHASTA REGIONAL MEDICAL GROUP, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 11, 2015

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

Authorized official

Name
Danielle Elaina Cutlip
Title
Practice Manager
Phone
(530) 605-4263

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

50 Alamo Ave
Weed, CA 96094-2352

Mailing address

50 Alamo Ave
Weed, CA 96094-2352
Phone (530) 605-4263

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090310000251 CA Part B Supplier - Clinic/Group Practice 5991861353 Receives reassigned benefits from 66 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anderson, CA; Redding, CA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Shasta Regional Med GRP Inc

Practitioners & affiliated clinicians

Practitioners 62

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 62

NPI Registry JSON

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439251200000",
    "number": "1588048680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 ALAMO AVE",
            "city": "WEED",
            "state": "CA",
            "postal_code": "960942352",
            "telephone_number": "530-605-4263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 ALAMO AVE",
            "city": "WEED",
            "state": "CA",
            "postal_code": "960942352",
            "telephone_number": "530-605-4263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHASTA REGIONAL MEDICAL GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHASTA REGIONAL MEDICAL GROUP, INC",
        "enumeration_date": "2015-07-17",
        "last_updated": "2015-08-11",
        "status": "A",
        "authorized_official_last_name": "CUTLIP",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_middle_name": "ELAINA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "530-605-4263"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Weed, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2015; 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.