FOLSOM LAKE PRIMARY CARE PC
NPI 1043705718
Internal Medicine in Folsom, CA
About Folsom Lake Primary Care Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FOLSOM LAKE PRIMARY CARE PC (NPI 1043705718) is a healthcare organization registered as an internal medicine in Folsom, California and active in the NPI registry since June 2018. The organization holds a CLIA Waiver certificate valid through May 2, 2027 and lists Hadi Firoz, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Folsom Lake Primary Care Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Folsom Lake Primary Care PC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 05D2060637
Folsom Lake Primary Care, PC · Folsom, CAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Folsom Lake Primary Care PC's NPI number?
The NPI number for Folsom Lake Primary Care PC is 1043705718. It was assigned to this organization in the NPPES registry on June 26, 2018.
Where is Folsom Lake Primary Care PC located?
Folsom Lake Primary Care PC is located at 2575 E Bidwell St Ste 210, Folsom, CA 95630. The listed phone number is (916) 984-7850.
What is Folsom Lake Primary Care PC's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Folsom Lake Primary Care PC enrolled in Medicare?
Yes. Folsom Lake Primary Care PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Folsom Lake Primary Care PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Folsom Lake Primary Care PC, in Internal Medicine and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Folsom Lake Primary Care PC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 05D2060637) is associated with this NPI, valid through May 2, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Folsom Lake Primary Care PC was last updated on June 26, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Folsom Lake Primary Care Pc · NPI 1043705718
Internal Medicine organization in Folsom, California. Organization record, active in the CMS NPPES registry since June 26, 2018.
## Identity
- **NPI:** 1043705718 (Entity type: Organization)
- **Enumerated:** June 26, 2018
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Organization subpart:** No
- **Authorized official:** Hadi Firoz, PRESIDENT
## Practice location
- **Address:** 2575 E BIDWELL ST STE 210, Folsom, CA 95630-6446
- **Phone:** (916) 984-7850
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Internal Medicine (1), Nurse Practitioner (1); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 26, 2018
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1043705718) · Data from the CMS NPPES public registry.