Active NPI
Rocklin Family Practice and Sports Medicine
- Family Medicine Physician
- Rocklin, CA
National Provider Identifier
1790798908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- 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
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Roy MC Harris, MD
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary | ||
| Sports Medicine (Family Medicine) Physician | 207QS0010X | |||
| Sports Medicine (Internal Medicine) Physician | 207RS0010X | |||
| Pediatrics Physician | 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
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G639720 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0860872 | Rocklin Family Practice and Sports Medicine | Certificate of waiver | Jul 17, 2027 |
National Provider Directory
National Provider DirectoryLocations
985 Sun City Ln
Ste 110
Lincoln, CA 95648
Phone (916) 624-0300
Practitioners & affiliated clinicians
Practitioners 19
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Sacramento, CA
- NPI 1457764235
CA, Family Medicine
-
- Sports Medicine (Family Medicine) Physician
- Rocklin, CA
- NPI 1205084910
CA, Sports Medicine
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": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G639720",
"state": "CA"
}
],
"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.