Yes
Marshall Medical Center - Marshall Hospital
1100 Marshall Way
Placerville, CA 95667
DSH050254A | Child | DSH | MARSHALL HOSPITAL | MMF OP INFUSION | 3581 PALMER DRIVE suite 400 | CAMERON PARK | CA | Active |
DSH050254AA | Child | DSH | MARSHALL HOSPITAL | MARSHALL ENT - ENT | 4300 Golden Center Drive Suite D | Placerville | CA | Active |
DSH050254AB | Child | DSH | MARSHALL HOSPITAL | MARSHALL ORTHOPEDICS AND SPORTS MEDICINE EL DORADO HILLS | 5137 GOLDEN FOOTHILL PARKWAY SUITE 120 | EL DORADO HILLS | CA | Active |
DSH050254AC | Child | DSH | MARSHALL HOSPITAL | MARSHALL PULMONOLOGY PLACERVILLE | 1004 FOWLER WAY SUITE 4 | PLACERVILLE | CA | Active |
DSH050254AD | Child | DSH | MARSHALL HOSPITAL | MARSHALL PULMONOLOGY - CP | 3501 Palmer Drive | Cameron Park | CA | Active |
DSH050254AE | Child | DSH | MARSHALL HOSPITAL | MARSHALL CARES - Addiction Treatment Center | 1045 Marshall Way | Placerville | CA | Terminated |
DSH050254AF | Child | DSH | MARSHALL HOSPITAL | MARSHALL CANCER CENTER | 3581 PALMER DRIVE Suite 400 | Cameron Park | CA | Active |
DSH050254AG | Child | DSH | MARSHALL HOSPITAL | MMF NEUROLOGY | 3581 Palmer Drive | Cameron Park | CA | Terminated |
DSH050254AH | Child | DSH | MARSHALL HOSPITAL | Diagnostic Imaging - CT Scanner | 3581 Palmer Drive | Cameron Park | CA | Active |
DSH050254AJ | Child | DSH | MARSHALL HOSPITAL | MMF CARDIOLOGY - EDH | 5137 Golden Foothill Parkway | El Dorado Hills | CA | Active |
DSH050254AK | Child | DSH | MARSHALL HOSPITAL | Diagnostic Imaging - MRI | 3581 Palmer Drive | Cameron Park | CA | Active |
DSH050254AL | Child | DSH | MARSHALL HOSPITAL | Diagnostic Imaging | 3581 Palmer Drive | Cameron Park | CA | Active |
DSH050254AM | Child | DSH | MARSHALL HOSPITAL | Physical Rehab SVCS - Outpatient | 1000 Fowler Way | Placerville | CA | Active |
DSH050254AN | Child | DSH | MARSHALL HOSPITAL | MARSHALL MEDICAL CENTER - RECOVERY - CAMERON PARK SURGERY CENTER | 3501 PALMER DR 100 | CAMERON PARK | CA | Active |
DSH050254AP | Child | DSH | MARSHALL HOSPITAL | MARSHALL MEDICAL CENTER - DIAGNOSTIC IMAGING - ULTRASOUND CAMERON PARK | 3581 PALMER DR 300 | CAMERON PARK | CA | Active |
DSH050254AQ | Child | DSH | MARSHALL HOSPITAL | MARSHALL MEDICAL CENTER - SURGERY - CAMERON PARK SURGERY CENTER | 3501 PALMER DR 100 | CAMERON PARK | CA | Active |
DSH050254B | Child | DSH | MARSHALL HOSPITAL | Cardiac Services - Cardiac Rehab | 1000 Fowler Way | Placerville | CA | Active |
DSH050254C | Child | DSH | MARSHALL HOSPITAL | MARSHALL OUTPATIENT SURGERY | 3501 PALMER DRIVE, SUITE 100 | CAMERON PARK | CA | Active |
DSH050254D | Child | DSH | MARSHALL HOSPITAL | DIVIDE WELLNESS CENTER | 6065 HIGHWAY 193 | GEORGETOWN | CA | Active |
DSH050254E | Child | DSH | MARSHALL HOSPITAL | MARSHALL CARDIOLOGY | 1004 FOWLER WAY, SUITE 4 | Placerville | CA | Active |
DSH050254F | Child | DSH | MARSHALL HOSPITAL | MARSHALL WHOLE CHILD HEALTH | 3106 Ponte Morino Drive, Suite B | CAMERON PARK | CA | Terminated |
DSH050254G | Child | DSH | MARSHALL HOSPITAL | MARSHALL EDH / FAMILY MEDICINE | 5137 GOLDEN FOOTHILL PKWY, #120 | EL DORADO HILLS | CA | Active |
DSH050254H | Child | DSH | MARSHALL HOSPITAL | MARSHALL RHEUMATOLOGY | 3501 PALMER DRIVE, SUITE 201 | Cameron Park | CA | Active |
DSH050254J | Child | DSH | MARSHALL HOSPITAL | MARSHALL SIERRA PRIMARY MEDICINE | 4341-B GOLDEN CENTER DRIVE | Placerville | CA | Active |
DSH050254K | Child | DSH | MARSHALL HOSPITAL | MARSHALL PEDIATRICS | 4341-A GOLDEN CENTER DRIVE | Placerville | CA | Active |
DSH050254L | Child | DSH | MARSHALL HOSPITAL | MARSHALL ORTHOPEDICS | 4300 GOLDEN CENTER DRIVE, #C | Placerville | CA | Active |
DSH050254M | Child | DSH | MARSHALL HOSPITAL | MARSHALL FAMILY MEDICINE CAMERON PARK | 3581 PALMER DRIVE, SUITE 602 | Cameron Park | CA | Active |
DSH050254N | Child | DSH | MARSHALL HOSPITAL | MARSHALL UROLOGY | 3501 PALMER DRIVE, SUITE 204 | Cameron Park | CA | Terminated |
DSH050254P | Child | DSH | MARSHALL HOSPITAL | MARSHALL OB/GYN CAMERON PARK | 3501 PALMER DRIVE, SUITE 204 | Cameron Park | CA | Terminated |
DSH050254Q | Child | DSH | MARSHALL HOSPITAL | MARSHALL WOUND CARE | 1095 MARSHALL WAY, SUITE 203 | Placerville | CA | Active |
DSH050254R | Child | DSH | MARSHALL HOSPITAL | MARSHALL GENERAL SURGERY | 1095 MARSHALL WAY, SUITE 202 | Placerville | CA | Active |
DSH050254S | Child | DSH | MARSHALL HOSPITAL | MARSHALL OB/GYN PLACERVILLE | 1095 MARSHALL WAY, SUITE 201 | Placerville | CA | Active |
DSH050254T | Child | DSH | MARSHALL HOSPITAL | MARSHALL FAMILY MEDICINE PLACERVILLE | 1095 MARSHALL WAY, SUITE 100 | PLACERVILLE | CA | Active |
DSH050254U | Child | DSH | MARSHALL HOSPITAL | MARSHALL GASTROENTEROLOGY | 3501 PALMER DR STE 201 | CAMERON PARK | CA | Active |
DSH050254V | Child | DSH | MARSHALL HOSPITAL | MARSHALL CARDIOLOGY CAMERON PARK | 3501 Palmer Drive | Cameron Park | CA | Active |
DSH050254W | Child | DSH | MARSHALL HOSPITAL | MARSHALL GASTROENTEROLOGY PLACERVILLE - GI PLACERVILLE | 1095 MARSHALL WAY SUITE 101 | PLACERVILLE | CA | Terminated |
DSH050254X | Child | DSH | MARSHALL HOSPITAL | MARSHALL UROLOGY PLACERVILLE | 1095 MARSHALL WAY SUITES 201 & 202 | PLACERVILLE | CA | Active |
DSH050254Y | Child | DSH | MARSHALL HOSPITAL | MARSHALL PODIATRY | 3501 PALMER DRIVE SUITE 201 | CAMERON PARK | CA | Active |
DSH050254Z | Child | DSH | MARSHALL HOSPITAL | MARSHALL PSYCHIATRY CAMERON PARK - PSYCH CP | 3581 PALMER DRIVE SUITE 202 | CAMERON PARK | CA | Terminated |
Details | State | Update | | To Be Terminated | Terminated | 7/1/2020 12:01 AM |
Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 2/28/2020 12:00:00 AM | 5/12/2020 1:29 PM |
Details | State | Update | Termination Request | Active | To Be Terminated | 5/12/2020 1:29 PM |
Terminations | Termination Comments | Update | Termination Request | | low volume | 5/12/2020 1:29 PM |
Terminations | Termination Date | Update | Termination Request | | 7/1/2020 12:00:00 AM | 5/12/2020 1:29 PM |
Terminations | Termination Effective Date | Update | Termination Request | | 5/1/2020 12:00:00 AM | 5/12/2020 1:29 PM |
Terminations | Termination Reason | Update | Termination Request | | Business decision by the Covered Entity | 5/12/2020 1:29 PM |
Addresses | Main Address | Update | Change Request |
5137 GOLDEN FOOTHILL PKWY, #120
EL DORADO HILLS, CA 95762 |
3106 Ponte Morino Drive, Suite B
CAMERON PARK, CA 95682-8277 | 3/18/2020 5:10 PM |
Details | Entity Subname | Update | Change Request | WHOLE CHILD HEALTH / Pediatrics | MARSHALL WHOLE CHILD HEALTH | 3/18/2020 5:10 PM |
Contacts | Authorizing Official | Update | AO Change Request | Whipple, James
Chief Executive Officer
Marshall Medical Center
5306262601 | Nelson, Siri
CEO
Marshall Medical Center
7073498127 | 12/31/2019 7:34 AM |
Details | Last Recertification Date | Update | Recertification | 8/21/2018 8:04:35 PM | 9/4/2019 5:27:00 PM | 9/4/2019 5:27 PM |
Details | Last Recertification Date | Update | Recertification | 11/16/2017 6:40:57 PM | 8/21/2018 8:04:35 PM | 8/21/2018 8:04 PM |
Details | Last Recertification Date | Update | Recertification | 8/12/2016 12:00:00 AM | 11/16/2017 6:40:57 PM | 11/16/2017 6:40 PM |
Contacts | Authorizing Official | Update | | Whipple, James
Chief Executive Officer
5306262601 | Whipple, James
Chief Executive Officer
Marshall Medical Center
5306262601 | 10/17/2017 2:19 PM |
Contacts | Signed By | Update | | Whipple, James
Chief Executive Officer
5306262601 | Whipple, James
Chief Executive Officer
Marshall Medical Center
5306262601 | 10/17/2017 2:19 PM |
Contacts | Primary Contact | Update | | DiPonti, Bob
Director of Pharmacy
5306262657 | DiPonti, Bob
Director of Pharmacy
Marshall med Ctr
5306262657 | 9/26/2017 7:53 PM |
Contacts | Authorizing Official | Insert | | | Whipple, James
Chief Executive Officer
5306262601 | 8/10/2017 10:39 PM |
Contacts | Signed By | Insert | | | Whipple, James
Chief Executive Officer
5306262601 | 8/10/2017 10:39 PM |
Contacts | Primary Contact | Insert | | | DiPonti, Bob
Director of Pharmacy
5306262657 | 12/12/2016 3:34 PM |
Addresses | Main Address | Insert | | |
5137 GOLDEN FOOTHILL PKWY, #120
EL DORADO HILLS, CA 95762 | 10/28/2016 6:29 PM |
Addresses | Billing Address | Insert | | | Marshall Medical Center - Accounts Payable
P.O. Box # 872
placerville, CA 95667 | 10/28/2016 6:29 PM |
Addresses | Shipping Address | Insert | | | Marshall Medical Center - Marshall Hospital
1100 Marshall way
placerville, CA 95667 | 10/28/2016 6:29 PM |
Details | Last Recertification Date | Update | | | 8/12/2016 12:00:00 AM | 8/12/2016 7:54 AM |
Dates | Participating Approval Date | Update | | | 3/1/2016 12:00:00 AM | 3/1/2016 4:56 PM |
Details | State | Update | | Pending | Active | 3/1/2016 4:56 PM |
Dates | Start Date | Update | | | 4/1/2016 12:00:00 AM | 3/1/2016 4:56 PM |
Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_56624 | DSH050254F | 2/24/2016 9:37 AM |
Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_56624 | 1/5/2016 4:02 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 1/5/2016 4:02 PM |
Medicaid Billing | Medicaid: Number | Insert | | | HSP40254F | 1/5/2016 4:02 PM |
Medicaid Billing | Medicaid: State | Insert | | | CA | 1/5/2016 4:02 PM |
Medicaid Billing | NPI: Number | Insert | | | 1972503142 | 1/5/2016 4:02 PM |
Details | Last Recertification Date | Insert | | | | 1/5/2016 4:02 PM |
Details | Grant Number | Insert | | | | 1/5/2016 4:02 PM |
Details | 340B ID | Insert | | | | 1/5/2016 4:02 PM |
Details | Is Authorizing Official EHB Data | Insert | | | | 1/5/2016 4:02 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/5/2016 4:02 PM |
Details | Medicare Provider Number | Insert | | | 050254 | 1/5/2016 4:02 PM |
Details | Entity Name | Insert | | | MARSHALL HOSPITAL | 1/5/2016 4:02 PM |
Details | Program Code | Insert | | | DSH | 1/5/2016 4:02 PM |
Details | Entity Subname | Insert | | | WHOLE CHILD HEALTH / Pediatrics | 1/5/2016 4:02 PM |
Dates | Participating Approval Date | Insert | | | | 1/5/2016 4:02 PM |
Details | State | Insert | | | Pending | 1/5/2016 4:02 PM |
Dates | Registration Date | Insert | | | 1/5/2016 12:00:00 AM | 1/5/2016 4:02 PM |
Dates | Signed By Date | Insert | | | 1/5/2016 12:00:00 AM | 1/5/2016 4:02 PM |
Dates | Start Date | Insert | | | | 1/5/2016 4:02 PM |
Terminations | Termination Comments | Insert | | | | 1/5/2016 4:02 PM |
Terminations | Termination Date | Insert | | | | 1/5/2016 4:02 PM |
Terminations | Termination Effective Date | Insert | | | | 1/5/2016 4:02 PM |
Terminations | Termination Reason | Insert | | | | 1/5/2016 4:02 PM |