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GREENHAVEN FAMILY PRACTICE, INC
NPI 1093137788
Family Medicine in Sacramento, CA

Active since January 14, 2014CLIA 05D2076883 · Waiver
1102 CORPORATE WAY, STE 170, SACRAMENTO, CA 95831(916) 661-5336(916) 382-4630 Get Directions Write a Review

NPPES record last updated: May 16, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 16, 2025, May 7, 2025 (2 updates tracked since 2025).

About Greenhaven Family Practice, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREENHAVEN FAMILY PRACTICE, INC (NPI 1093137788) is a healthcare organization registered as a family medicine in Sacramento, California and active in the NPI registry since January 2014. The organization holds a CLIA Waiver certificate valid through April 28, 2028 and lists Scarlett Tan Lu, Owner, as its authorized official.

NPPES Registry Identity

NPI1093137788
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameGREENHAVEN FAMILY PRACTICE, INC
Location Address1102 CORPORATE WAY, STE 170Sacramento, CA 95831-3895
Mailing Address1102 Corporate Way, Ste 170Sacramento, CA 95831-3895 · (916) 661-5336 · Fax (916) 382-4630
Phone(916) 661-5336
Fax(916) 382-4630
Organization SubpartNo
Authorized OfficialScarlett Tan LuOwner · (916) 661-5336
Enumeration DateJanuary 14, 2014
Last NPPES UpdateMay 16, 20252 updates tracked since enumeration
NPPES CertifiedMay 16, 2025
✔ NPI 1093137788 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in CA · 20A8387
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1102 CORPORATE WAY, Sacramento, CA 95831
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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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Greenhaven Family Practice, Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Greenhaven Family Practice, Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Scarlett Lu, DO
Family Practice
NPI 1548373491
1102 CORPORATE WAY SUITE 170
Sacramento, CA 95831
(916) 661-5336
✔ PECOS✔ Accepts MedicareSame address

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 05D2076883

Greenhaven Family Practice · Sacramento, CA
Active · expires Apr 28, 2028
CLIA Number05D2076883
Laboratory TypePhysician Office
Certificate Effective DateApril 29, 2026
Certificate Expiration DateApril 28, 2028
Laboratory DirectorScarlett Lu, Do
Laboratory Phone(916) 661-5336
Laboratory LocationGreenhaven Family Practice1102 Corporate Way Ste 170, Sacramento, CA 95831
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Greenhaven Family Practice, Inc's NPI number?

The NPI number for Greenhaven Family Practice, Inc is 1093137788. It was assigned to this organization in the NPPES registry on January 14, 2014.

Where is Greenhaven Family Practice, Inc located?

Greenhaven Family Practice, Inc is located at 1102 Corporate Way Ste 170, Sacramento, CA 95831. The listed phone number is (916) 661-5336.

What is Greenhaven Family Practice, Inc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Greenhaven Family Practice, Inc enrolled in Medicare?

Yes. Greenhaven Family Practice, Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Greenhaven Family Practice, Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Greenhaven Family Practice, Inc. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Greenhaven Family Practice, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2076883) is associated with this NPI, valid through April 28, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Greenhaven Family Practice, Inc was last updated on May 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months 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.