NPIMap

Organization Active NPI

Roseville Cardiology Medical Associates, Inc.

  • Cardiovascular Disease Physician
  • Roseville, CA
National Provider Identifier
1699718312
Registry record updated Aug 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
A41602 Issued in CA
Legal business name
ROSEVILLE CARDIOLOGY MEDICAL ASSOCIATES, INC.
Practice address
2 Medical Plaza Dr
#175
Roseville, CA 95661-3049
Phone
(916) 782-2146
Fax
(916) 782-4299
NPI assigned
Jun 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2012

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

Authorized official

Name
Dr. David Bennett Wampold, M.D.NPI 1932171956
Title
President
Phone
(916) 782-2146

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X A41602 CA Primary

Addresses

Primary practice location

2 Medical Plaza Dr
#175
Roseville, CA 95661-3049

Mailing address

2 Medical Plaza Dr
#175
Roseville, CA 95661-3049
Phone (916) 782-2146

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ06970ZOtherBLUE SHIELD
GR0094900MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040325001752 CA Part B Supplier - Clinic/Group Practice 4688566573 Receives reassigned benefits from 17 practitioners
Practice locations: Auburn, CA; Lincoln, CA; Roseville, CA

National Provider Directory

National Provider Directory

Locations

685 Twelve Bridges Dr
Ste G
Lincoln, CA 95648
Phone (916) 408-5478

2 Medical Plaza Dr
Ste 150
Roseville, CA 95661

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346284800000",
    "number": "1699718312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 MEDICAL PLAZA DR",
            "address_2": "#175",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613049",
            "telephone_number": "916-782-2146",
            "fax_number": "916-782-4299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MEDICAL PLAZA DR",
            "address_2": "#175",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613049",
            "telephone_number": "916-782-2146",
            "fax_number": "916-782-4299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSEVILLE CARDIOLOGY MEDICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2012-08-30",
        "status": "A",
        "authorized_official_last_name": "WAMPOLD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "BENNETT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-782-2146",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "A41602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ06970Z",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0094900",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2012; 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.