Active NPI
Dignity Health Medical Foundation
Doing business as Mercy Medical Group, a service of Dignity Health Medical Foundation
- Adolescent and Children Mental Health Clinic/Center
- Sacramento, CA
National Provider Identifier
1942334339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adolescent and Children Mental Health Clinic/Center
- Legal business name
- DIGNITY HEALTH MEDICAL FOUNDATION
- Doing business as
- Mercy Medical Group, a service of Dignity Health Medical Foundation
- Practice address
- 1792 Tribute Rd
Suite 350
Sacramento, CA 95815-4305 - Phone
- (916) 924-6400
- Fax
- (916) 648-9869
- NPI assigned
- Mar 15, 2007
- Last updated
- Nov 18, 2020
- Organization subpart
- Yes
- Parent organization
- DIGNITY HEALTH MEDICAL FOUNDATION
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X | NU | Primary |
Addresses
Primary practice location
1792 Tribute Rd
Suite 350
Sacramento, CA 95815-4305
Mailing address
PO Box 60000
File #72938
San Francisco, CA 94160-2938
Phone (916) 733-3397
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0019838 | Other | CIGNA | |
| 476040021 | Other | DME SUPPLIER # | |
| 195 | Other | HEALTH NET | |
| GR006356C | Medicaid | CA | |
| ZZZ60278Z | Other | BLUE SHIELD | |
| ZZZ29342Z | Other | BSCA PRO FEES | |
| 341996544 | Other | SPECIAL PURPOSE TAX ID # | |
| 983 | Other | HEALTH NET |
Other names 1
- Mercy Medical Group, a service of Dignity Health Medical Foundation
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
National Provider Directory- Part of
- Woodland Clinic Med GRP
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173916800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1605657600000",
"number": "1942334339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 60000",
"address_2": "FILE #72938",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941602938",
"telephone_number": "916-733-3397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1792 TRIBUTE RD",
"address_2": "SUITE 350",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958154305",
"telephone_number": "916-924-6400",
"fax_number": "916-648-9869"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DIGNITY HEALTH MEDICAL FOUNDATION",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "DIGNITY HEALTH MEDICAL FOUNDATION",
"enumeration_date": "2007-03-15",
"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": "261QM0855X",
"taxonomy_group": "",
"desc": "Clinic/Center, Adolescent and Children Mental Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "0019838",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DME SUPPLIER #",
"identifier": "476040021",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NET",
"identifier": "195",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR006356C",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "ZZZ60278Z",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BSCA PRO FEES",
"identifier": "ZZZ29342Z",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPECIAL PURPOSE TAX ID #",
"identifier": "341996544",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NET",
"identifier": "983",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Mercy Medical Group, a service of Dignity Health Medical Foundation",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Mercy Medical Group, a service of Dignity Health Medical Foundation",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Sacramento, CA
- Dignity Health Medical Foundation
- Dignity Health Medical Foundation (Mercy Medical Group, a service of Dignity Health Medical Foundation)
- Dignity Health Medical Foundation (MercyClinic Norwood, a service of Dignity Health Medical Foundation)
- Dignity Health Medical Foundation (Mercy Medical Group, a service of Dignity Health Medical Foundation)
- Dignity Health Medical Foundation (Mercy Medical Group, a service of Dignity Health Medical Foundation)
- Dignity Health Medical Foundation (Children's South)
- Angela Digrande, PNP
- Nwanneka Dike
- Star Dikousman
- Rubina Dildar
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.