Shingle Springs Rancheria

Primary specialty

Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X

License

PHY55274 Issued in CA

Legal business name

SHINGLE SPRINGS RANCHERIA

Doing business as

Shingle Springs Health and Wellness Center

Practice address

5168 Honpie Rd
5TH Floor
Placerville, CA 95667-8682

Phone

(530) 387-8215

Fax

(530) 676-4416

NPI assigned

Jan 13, 2017

Organization subpart

No

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

Authorized official

Name

John Bodtker, PHARMD

Title

Director of Pharmacy/Pic/Ao

Phone

(530) 387-8005

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Shingle Springs Health and Wellness Center Doing business as

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

{
    "created_epoch": "1484265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1710423793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5168 HONPIE RD",
            "address_2": "5TH FLOOR",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956678682",
            "telephone_number": "530-387-8005",
            "fax_number": "530-387-8006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5168 HONPIE RD",
            "address_2": "5TH FLOOR",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956678682",
            "telephone_number": "530-387-8215",
            "fax_number": "530-676-4416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINGLE SPRINGS RANCHERIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-13",
        "last_updated": "2025-09-19",
        "status": "A",
        "authorized_official_last_name": "BODTKER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY/PIC/AO",
        "authorized_official_telephone_number": "530-387-8005",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "CA",
            "license": "PHY55274",
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710423793",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2167303",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shingle Springs Health and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shingle Springs Health and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shawn M McDonald OD a Professional Corporation
• Laura Jane Shepherd
• Matthew Hugh Shepherd, DC
• Shannon Sherman, MFT TRAINEE
• Shingle Springs Rancheria (Shingle Springs Health and Wellness Center)
• Mohammed Fazil Siddiqi, MD
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• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Placerville, CA
• Providers in Placerville, CA by specialty
• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.