NPIMap

Organization Active NPI

CHW Medical Foundation

Doing business as Mercy Imaging Centers, a Service of CHW Medical Foundation

  • Mammography Clinic/Center
  • Carmichael, CA
National Provider Identifier
1679503759
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mammography Clinic/CenterTaxonomy code 261QR0206X
License
18528 Issued in CA
Legal business name
CHW MEDICAL FOUNDATION
Doing business as
Mercy Imaging Centers, a Service of CHW Medical Foundation
Practice address
6620 Coyle Ave
Suite 107
Carmichael, CA 95608-6333
Phone
(916) 961-6946
Fax
(916) 961-7217
NPI assigned
Jul 4, 2006
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
Mammography Clinic/Center 261QR0206X 18528 CA Primary

Addresses

Primary practice location

6620 Coyle Ave
Suite 107
Carmichael, CA 95608-6333

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
GR0011372OtherCAMEDI-CAL
ZZZ17567ZOtherCABLUE SHIELD

Other names 1

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000709 CA Part B Supplier - Clinic/Group Practice 7810800661 Receives reassigned benefits from 1,333 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Part of
Woodland Clinic Med GRP

Practitioners & affiliated clinicians

Practitioners 10

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": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1679503759",
    "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": "916-733-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6620 COYLE AVE",
            "address_2": "SUITE 107",
            "city": "CARMICHAEL",
            "state": "CA",
            "postal_code": "956086333",
            "telephone_number": "916-961-6946",
            "fax_number": "916-961-7217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHW MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHW MEDICAL FOUNDATION",
        "enumeration_date": "2006-07-04",
        "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": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": "CA",
            "license": "18528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "GR0011372",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ17567Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Imaging Centers, a Service of CHW Medical Foundation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Imaging Centers, a Service of CHW Medical Foundation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carmichael, 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.
  • 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.