CHW Medical Foundation

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

CHW MEDICAL FOUNDATION

Doing business as

Mercy Medical Group, a Service of CHW Medical Foundation

Practice address

4987 Golden Foothill Pkwy
El Dorado Hills, CA 95762-9636

Phone

(916) 933-4222

Fax

(916) 933-5574

NPI assigned

Jul 16, 2009

Last updated

Nov 18, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

CHW MEDICAL FOUNDATIONAs reported in NPPES

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

Addresses

Other names 1

• Mercy Medical Group, a Service of CHW Medical Foundation Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Part of

Woodland Clinic Med GRP

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

{
    "created_epoch": "1247702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1942430566",
    "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": "916-859-1671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4987 GOLDEN FOOTHILL PKWY",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957629636",
            "telephone_number": "916-933-4222",
            "fax_number": "916-933-5574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHW MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHW MEDICAL FOUNDATION",
        "enumeration_date": "2009-07-16",
        "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": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Medical Group, a Service of CHW Medical Foundation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Medical Group, a Service of CHW Medical Foundation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Multi-Specialty Clinic/Center in El Dorado Hills, CA
• Providers in El Dorado Hills, CA by specialty
• Multi-Specialty Clinic/Center in California

• 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.

Verify at the official NPI Registry.