C O R E Medical Clinic Inc

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

Legal business name

C O R E MEDICAL CLINIC INC

Practice address

3990 Industrial Blvd
West Sacramento, CA 95691-3430

Phone

(916) 442-4985

NPI assigned

Sep 24, 2018

Organization subpart

Yes

Parent organization

C O R E MEDICAL CLINIC INCAs reported in NPPES

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

Authorized official

Name

Marshall Stenson

Title

Business Services Director

Phone

(916) 442-4985

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• C O R E Medical Clinic Inc

  • Methadone Clinic
  • Sacramento, CA
  • NPI 1326283706

  O20100120000190, O20200213003019

  Same enrollment

Tax ID family

C O R E Medcai Clinic Inc2 organizations share this tax ID, including this one

Part of

C O R E Medcai Clinic Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• C O R E Medical Clinic Inc

  • Methadone Clinic
  • Sacramento, CA
  • NPI 1326283706
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• C O R E Medical Clinic Inc

  • Methadone Clinic
  • Sacramento, CA
  • NPI 1326283706
  NPPES parent name

Practitioners 7

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

• Jennifer Ann Bale, CADC CAS

  • Addiction (Substance Use Disorder) Counselor
  • Sacramento, CA
  • NPI 1104971456
  NPD
• Nelly Jazmin Arceo Fabian, LVN

  • Licensed Vocational Nurse
  • West Sacramento, CA
  • NPI 1144872987
  NPD (past)
• Cynthia Ann Giddings, LCSW, SUDCC-IV CS

  • Clinical Social Worker
  • Elk Grove, CA
  • NPI 1548600497
  NPD (past)
• Renee Yvonne Hudson, RADT1

  • Addiction (Substance Use Disorder) Counselor
  • Sacramento, CA
  • NPI 1528566700
  NPD (past)
• Parita Shah, P.A.-C

  • Physician Assistant
  • Sacramento, CA
  • NPI 1073914750
  NPD (past)
• Michelle Renee Wood, CADC I

  • Addiction (Substance Use Disorder) Counselor
  • Sacramento, CA
  • NPI 1811455264
  NPD (past)
• Phillip Jared Summers, MD, MPH

  • Emergency Medicine Physician
  • Tucson, AZ
  • NPI 1154666824
  NPD (past)

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

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701993600000",
    "number": "1750865804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 CAPITOL AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958165721",
            "telephone_number": "916-442-4985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 INDUSTRIAL BLVD",
            "city": "WEST SACRAMENTO",
            "state": "CA",
            "postal_code": "956913430",
            "telephone_number": "916-442-4985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C O R E MEDICAL CLINIC INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "C O R E MEDICAL CLINIC INC",
        "enumeration_date": "2018-09-24",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A",
        "authorized_official_last_name": "STENSON",
        "authorized_official_first_name": "MARSHALL",
        "authorized_official_title_or_position": "BUSINESS SERVICES DIRECTOR",
        "authorized_official_telephone_number": "916-442-4985"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hoa Bui
• Thomas Thanh Bui, PHARM.D.
• Sharee Burgess
• Cheryl Ann Buringrud, PT
• Bianca Butler
• Zarina Cadiz
• Beverley Elizabeth Calderone, M.A
• Daresha L Caldwelldixon
• Colleen Callaghan, MD
• Bonita M Campbell, MSW

• Methadone Clinic in West Sacramento, CA
• Providers in West Sacramento, CA by specialty
• Methadone Clinic in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; 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.