NPIMap

Organization Active NPI

Dignity Health Medical Foundation

  • Radiology Clinic/Center
  • Roseville, CA
National Provider Identifier
1821028200
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
DIGNITY HEALTH MEDICAL FOUNDATION
Practice address
2110 Professional Dr
Suite 190
Roseville, CA 95661-3752
Phone
(916) 787-0404
Fax
(916) 787-0434
NPI assigned
Jul 3, 2006
Organization subpart
Yes
Parent organization
DIGNITY HEALTH MEDICAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

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

Authorized official

Name
Theresa M Hylen
Title
Chief Financial Officer
Phone
(916) 851-2559

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

2110 Professional Dr
Suite 190
Roseville, CA 95661-3752

Mailing address

3000 Q St
Sacramento, CA 95816-7058
Phone (916) 733-5701

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ25297ZOtherCABLUE SHIELD
GR001137JOtherCAMEDI-CAL

Other names 1

  • Mercy Imaging Centers, a service of Dignity Health Medical Foundation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000709 CA Part B Supplier - Clinic/Group Practice 7810800661 Receives reassigned benefits from 1,333 practitioners
This NPI is an additional NPI on the enrollment

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
05D0911591Dignity Health Medical Foundation2110 Professional Dr Ste 120, Roseville, CA 95661Provider-performed microscopyFeb 8, 2028

National Provider Directory

National Provider Directory
Part of
Woodland Clinic Med GRP

Locations

8259 Laguna Blvd
Ste 100
Elk Grove, CA 95758
Phone (916) 691-8570

2110 Professional Dr
Ste 190
Roseville, CA 95661
Phone (916) 787-0404

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1821028200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 Q ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958167058",
            "telephone_number": "916-733-5701",
            "fax_number": "916-733-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 PROFESSIONAL DR",
            "address_2": "SUITE 190",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613752",
            "telephone_number": "916-787-0404",
            "fax_number": "916-787-0434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGNITY HEALTH MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIGNITY HEALTH MEDICAL FOUNDATION",
        "enumeration_date": "2006-07-03",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "HYLEN",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "916-851-2559"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ25297Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "GR001137J",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Imaging Centers, a service of Dignity Health Medical Foundation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Imaging Centers, a service of Dignity Health Medical Foundation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; 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.