NPIMap

Organization Active NPI

Rocklin Family Practice and Sports Medicine

  • Family Medicine Physician
  • Rocklin, CA
National Provider Identifier
1790798908
Registry record updated Apr 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ROCKLIN FAMILY PRACTICE AND SPORTS MEDICINE
Practice address
3104 Sunset Blvd
#2B
Rocklin, CA 95677
Phone
(916) 624-0300
Fax
(916) 624-0631
NPI assigned
Aug 15, 2006
Last updated
Apr 4, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2017

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

Authorized official

Name
Roy MC Harris, MDNPI 1780692533
Title
President
Phone
(916) 624-0300

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X
Sports Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0010X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

3104 Sunset Blvd
#2B
Rocklin, CA 95677

Mailing address

3104 Sunset Blvd
#2B
Rocklin, CA 95677
Phone (916) 624-0300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040719000734 CA Part B Supplier - Clinic/Group Practice 5395724777 Receives reassigned benefits from 18 practitioners
Practice locations: Lincoln, CA; Rocklin, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0860872Rocklin Family Practice and Sports Medicine3104 Sunset Boulevard Suite 2B, Rocklin, CA 95677Certificate of waiverJul 17, 2027

National Provider Directory

National Provider Directory

Locations

985 Sun City Ln
Ste 110
Lincoln, CA 95648
Phone (916) 624-0300

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491264000000",
    "number": "1790798908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3104 SUNSET BLVD",
            "address_2": "#2B",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "95677",
            "telephone_number": "916-624-0300",
            "fax_number": "916-624-0631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3104 SUNSET BLVD",
            "address_2": "#2B",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "95677",
            "telephone_number": "916-624-0300",
            "fax_number": "916-624-0631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKLIN FAMILY PRACTICE AND SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2017-04-04",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "ROY",
        "authorized_official_middle_name": "MC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-624-0300",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rocklin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.