Individual provider Active NPI

Craig C Corp, M.D.

  • Pediatrics Physician
  • Roseville, CA
National Provider Identifier
1821090945
Registry record updated Jul 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
G84068 Issued in CA
Practice address
3100 Douglas Blvd
Roseville, CA 95661-3866
Phone
(916) 779-8500
Fax
(916) 731-3422
NPI assigned
Jun 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X G84068 CA Primary

Addresses

Primary practice location

3100 Douglas Blvd
Roseville, CA 95661-3866

Mailing address

10470 Old Placerville Rd
Suite 100
Sacramento, CA 95827-2539
Phone (800) 470-0071

Other identifiers 1

IdentifierTypeStateIssuer
00G840680MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140625001143 CA Practitioner - Pediatric Medicine 4981829496 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G84068CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation Pediatrics CurrentSince Jul 14, 2014 Accepting new patients
Sutter Valley Medical Foundation Pediatrics Current Accepting new patients
Sutter Valley Medical Foundation CurrentSince Jul 14, 2014 Accepting new patients
Enloe Medical Center Past Accepting new patients
Sutter North Medical Foundation Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients

Locations

2050 Blue Oaks Blvd
Roseville, CA 95747
Phone (916) 910-2400

3100 Douglas Blvd
Roseville, CA 95661
Phone (916) 774-8300

10470 Old Placerville Rd
Ste 100
Sacramento, CA 95827

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

Interoperability endpoints

  • Direct secure messaging: ccorp207779@hisp.ehr.sutterhealth.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437955200000",
    "number": "1821090945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10470 OLD PLACERVILLE RD",
            "address_2": "SUITE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272539",
            "telephone_number": "800-470-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 DOUGLAS BLVD",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613866",
            "telephone_number": "916-779-8500",
            "fax_number": "916-731-3422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORP",
        "first_name": "CRAIG",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2015-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G84068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G840680",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

Verify at the official NPI Registry.