NPIMap

Organization Active NPI

Marshall Medical Center

  • Family Medicine Physician
  • Cameron Park, CA
National Provider Identifier
1871697904
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MARSHALL MEDICAL CENTER
Practice address
3581 Palmer Drive
Suite 602
Cameron Park, CA 95682
Phone
(530) 626-2920
NPI assigned
Sep 11, 2006
Last updated
Sep 8, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

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

Authorized official

Name
Mrs. Siri Nelson
Title
Ceo
Phone
(530) 626-2601

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X CA Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X CA

Addresses

Primary practice location

3581 Palmer Drive
Suite 602
Cameron Park, CA 95682

Mailing address

P.O. Box 45680
San Francisco, CA 94145
Phone (530) 626-2920

Other practice location 1

3581 Palmer Dr Ste 202
Cameron Park, CA 95682-8237
Phone (530) 672-7000

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ00439ZMedicaidCA
CT1847OtherCARAIL ROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031208001095 CA Part B Supplier - Clinic/Group Practice 7517875859 Receives reassigned benefits from 169 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Placerville, CA; Twin Bridges, CA; Gold River, CA; El Dorado Hills, CA; Cameron Park, CA

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Marshall Medical Center for18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Locations

3106 Ponte Morino Dr
Ste B
Cameron Park, CA 95682
Phone (530) 631-1310

1045 Marshall Way
Placerville, CA 95667
Phone (530) 621-7965

1095 Marshall Way
#100
Placerville, CA 95667
Phone (530) 626-2920

1095 Marshall Way
Ste 201
Placerville, CA 95667
Phone (530) 344-5470

3581 Palmer Dr
Ste 602
San Francisco, CA 94145

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1871697904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 45680",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "94145",
            "telephone_number": "530-626-2920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3581 PALMER DRIVE",
            "address_2": "SUITE 602",
            "city": "CAMERON PARK",
            "state": "CA",
            "postal_code": "95682",
            "telephone_number": "530-626-2920"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3581 Palmer Dr Ste 202",
            "address_purpose": "LOCATION",
            "city": "Cameron Park",
            "state": "CA",
            "postal_code": "956828237",
            "country_code": "US",
            "telephone_number": "530-672-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MARSHALL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-11",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "SIRI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "530-626-2601",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ00439Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "CT1847",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cameron Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; 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.