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FOLSOM LAKE PRIMARY CARE PC
NPI 1043705718
Internal Medicine in Folsom, CA

Active since June 26, 2018CLIA 05D2060637 · Waiver
2575 E BIDWELL ST STE 210, FOLSOM, CA 95630(916) 984-7850 Get Directions Write a Review

NPPES record last updated: June 26, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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

NPI1043705718
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameFOLSOM LAKE PRIMARY CARE PC
Location Address2575 E BIDWELL ST STE 210Folsom, CA 95630-6446
Mailing Address271 American River Canyon DrFolsom, CA 95630-7143
Phone(916) 984-7850
Organization SubpartNo
Authorized OfficialHadi FirozPresident · (916) 790-0450
Enumeration DateJune 26, 2018
✔ NPI 1043705718 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in CA · C56218
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
2575 E BIDWELL ST STE 210, Folsom, CA 95630
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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, CA
Active · expires May 2, 2027
CLIA Number05D2060637
Laboratory TypePhysician Office
Certificate Effective DateMay 3, 2025
Certificate Expiration DateMay 2, 2027
Laboratory DirectorHadi Firoz
Laboratory Phone(916) 984-7850
Laboratory LocationFolsom Lake Primary Care, PC2575 E Bidwell St, Ste 210, Folsom, CA 95630
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ASPEN PEROVICH PA-C, MS, RDN
Physician Assistant
2575 E BIDWELL ST STE 210
FOLSOM, CA 95630
Sacramento County (916) 984-7850
SARA REZAIE PA-C
Internal Medicine
2575 E BIDWELL ST STE 210
FOLSOM, CA 95630
Sacramento County (916) 984-7850

Frequently 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.

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.