Folsom Family and Sports Medical Group Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A64163 Issued in CA

Legal business name

FOLSOM FAMILY AND SPORTS MEDICAL GROUP INC.

Practice address

2545 E Bidwell St Ste 110
Folsom, CA 95630-6443

Phone

(916) 941-7362

Fax

(866) 779-3899

NPI assigned

Dec 28, 2010

Organization subpart

No

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

Authorized official

Name

Melanie Miller

Title

Manager

Phone

(916) 365-3431

Specialties & licenses 2

Addresses

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

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelley Manion Leonard, CRNP

  • Family Nurse Practitioner
  • Folsom, CA
  • NPI 1275822520
  Medicare reassignment NPD
• Cheryl Ann Matossian, M.D.

  • Sports Medicine (Family Medicine) Physician
  • Folsom, CA
  • NPI 1740379072
  Medicare reassignment NPD

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

{
    "created_epoch": "1293494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735603200000",
    "number": "1629372073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2545 E BIDWELL ST STE 110",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956306443",
            "telephone_number": "916-941-7362",
            "fax_number": "866-779-3899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2545 E BIDWELL ST STE 110",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956306443",
            "telephone_number": "916-941-7362",
            "fax_number": "866-779-3899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOLSOM FAMILY AND SPORTS MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-28",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "916-365-3431"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A64163",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Folsom City MD
• Folsom Countryhouse Op Co LLLP
• Folsom Dental Group
• Folsom Dermatology
• Folsom Endoscopy Center LLC
• Folsom in-Patient Medical Group
• Folsom Lake Primary Care PC
• Folsom Medical Practice Inc
• Folsom Medical Supply LLC
• Folsom Obstetrics & Gynecology Medical Group Inc

• Family Medicine Physician in Folsom, CA
• Providers in Folsom, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2024; 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.