NPIMap

Individual provider Active NPI

Samuel J W Ceridon, M.D.

  • Family Medicine Physician
  • Placerville, CA
National Provider Identifier
1679800247
Registry record updated Sep 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A116725 Issued in CA
Practice address
1095 Marshall Way
Placerville, CA 95667-5722
Phone
(530) 626-2920
Fax
(530) 748-0328
NPI assigned
Nov 3, 2009
Last updated
Sep 17, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A116725 CA Primary

Addresses

Primary practice location

1095 Marshall Way
Placerville, CA 95667-5722

Mailing address

1095 Marshall Way
Placerville, CA 95667-5722
Phone (530) 626-2920

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120802000216 CA Practitioner - Family Practice 0446406797 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Colorado School of Medicine, Denver, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Marshall Medical CenterGroup PAC ID 7517875859, 168 clinicians

Practice addresses (Care Compare)

1095 Marshall Way
Suite 100
Placerville, CA 95667-5722
Phone (530) 626-2920

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue262
Removal of skin lesions60
Removal of nail tissue1-10
Removal or shaving of skin growth37
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A116725CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marshall Medical Center Family Medicine CurrentSince Nov 1, 2019 Accepting new patients
Marshall Medical Center Family Medicine CurrentSince Nov 1, 2019 Accepting new patients
Marshall Medical Center Past Accepting new patients
Marshall Medical Center Past Accepting new patients

Locations

3581 Palmer Dr
Ste 602
Cameron Park, CA 95682
Phone (530) 626-2920

4201 Town Center Blvd
Bldg D
El Dorado Hills, CA 95762
Phone (530) 344-5400

5137 Golden Foothill Pkwy
Ste 120
El Dorado Hls, CA 95762
Phone (530) 344-5400

1095 Marshall Way
Ste 100
Placerville, CA 95667
Phone (530) 344-5470

1004 Fowler Way
Ste 4
Placerville, CA 95667
Phone (530) 626-9488

1095 Marshall Way
Ste 201
Placerville, CA 95667
Phone (530) 344-5470

1095 Marshall Way
Placerville, CA 95667
Phone (530) 626-2920

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1257206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347840000000",
    "number": "1679800247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1095 MARSHALL WAY",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956675722",
            "telephone_number": "530-626-2920",
            "fax_number": "530-748-0328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 MARSHALL WAY",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956675722",
            "telephone_number": "530-626-2920",
            "fax_number": "530-748-0328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CERIDON",
        "first_name": "SAMUEL",
        "middle_name": "J W",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-03",
        "last_updated": "2012-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A116725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Placerville, CA

Sources for this page

Verify at the official NPI Registry.