NPIMap

Organization Active NPI

Marshall Medical Center

Doing business as Center for Sports Rehabilitation and Active Living

  • Rehabilitation Clinic/Center
  • El Dorado Hills, CA
National Provider Identifier
1972309326
Registry record updated Sep 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
MARSHALL MEDICAL CENTER
Doing business as
Center for Sports Rehabilitation and Active Living
Practice address
4201 Town Center Blvd BLDG D
El Dorado Hills, CA 95762-7100
Phone
(530) 344-5464
NPI assigned
Feb 24, 2025
Last updated
Sep 25, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
MARSHALL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 25, 2026

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

Authorized official

Name
Martin Entwistle
Title
Interim Ceo
Phone
(530) 626-2868

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

4201 Town Center Blvd BLDG D
El Dorado Hills, CA 95762-7100

Mailing address

1100 Marshall Way
Placerville, CA 95667-6533
Phone (530) 622-1441

Other names 1

  • Center for Sports Rehabilitation and Active Living Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250701003855 CA Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 7517875859 Practice locations: El Dorado Hills, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972309326. Details of each certification follow.

  • CCN 556589 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 556589

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CENTER FOR SPORTS REHABILITATION AND ACTIVE LIVING
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Sep 4, 2025
Last certification
Sep 4, 2025
Ownership / control type
Voluntary Non-Profit Other Than Church
Facility address
4201 Town Center Blvd
El Dorado Hills, CA 95762

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

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

Other organizations with this tax ID 17

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

View all 17

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Divide Wellness CenterGeorgetown, CA, CCN 058514 Rural health clinic Operational/Managerial Control Jun 1, 2009

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1740355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790294400000",
    "number": "1972309326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 MARSHALL WAY",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956676533",
            "telephone_number": "530-622-1441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 TOWN CENTER BLVD BLDG D",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957627100",
            "telephone_number": "530-344-5464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARSHALL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARSHALL MEDICAL CENTER",
        "enumeration_date": "2025-02-24",
        "last_updated": "2026-09-25",
        "certification_date": "2026-09-25",
        "status": "A",
        "authorized_official_last_name": "ENTWISTLE",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "INTERIM CEO",
        "authorized_official_telephone_number": "530-626-2868"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Sports Rehabilitation and Active Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Dorado Hills, CA

Sources for this page

Verify at the official NPI Registry.