NPIMap

Organization Active NPI

Empowerme Medical Group, PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Granite Bay, CA
National Provider Identifier
1811737604
Registry record updated May 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
EMPOWERME MEDICAL GROUP, PC
Practice address
9747 Sierra College Blvd
Granite Bay, CA 95746-6320
Phone
(877) 367-9772
NPI assigned
May 29, 2024
Last updated
May 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2024

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

Authorized official

Name
David Church
Title
VP of Finance
Phone
(618) 972-5228

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X Primary

Addresses

Primary practice location

9747 Sierra College Blvd
Granite Bay, CA 95746-6320

Mailing address

1335 Strassner Dr
Brentwood, MO 63144-1872
Phone (877) 367-9772

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240619002366 CA Part B Supplier - Clinic/Group Practice 7214392059 Receives reassigned benefits from 9 practitioners
Practice locations: Granite Bay, CA

Other NPIs with the same Medicare PAC ID 22

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 22

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1716940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716940800000",
    "number": "1811737604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1335 STRASSNER DR",
            "city": "BRENTWOOD",
            "state": "MO",
            "postal_code": "631441872",
            "telephone_number": "877-367-9772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9747 SIERRA COLLEGE BLVD",
            "city": "GRANITE BAY",
            "state": "CA",
            "postal_code": "957466320",
            "telephone_number": "877-367-9772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMPOWERME MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-29",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A",
        "authorized_official_last_name": "CHURCH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "618-972-5228"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Granite Bay, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; 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.