MERCY DOCTORS MEDICAL GROUP INC

Provider Demographics

• NPI: 1801809447
• Name: MERCY DOCTORS MEDICAL GROUP INC
• Entity type: Organization
• Organization Name: MERCY DOCTORS MEDICAL GROUP INC
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: DR
• Authorized Official - First Name: CARL
• Authorized Official - Middle Name: E
• Authorized Official - Last Name: BRICCA
• Authorized Official - Credentials: DO
• Authorized Official - Phone: 415-752-0100
• Mailing Address - Street 1: 1 SHRADER ST
• Mailing Address - Street 2: SUITE 640
• Mailing Address - City: SAN FRANCISCO
• Mailing Address - State: CA
• Mailing Address - Zip Code: 94117-1016
• Mailing Address - Country: US
• Mailing Address - Phone: 415-752-0100
• Mailing Address - Fax: 415-752-7103
• Practice Address - Street 1: 1 SHRADER ST
• Practice Address - Street 2: SUITE 640
• Practice Address - City: SAN FRANCISCO
• Practice Address - State: CA
• Practice Address - Zip Code: 94117-1016
• Practice Address - Country: US
• Practice Address - Phone: 415-752-0100
• Practice Address - Fax: 415-752-7103
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-08-14
• Last Update Date: 2014-08-19

Provider Licenses

State	License ID	Taxonomies
CA	20A6178	207R00000X
CA	C24372	207R00000X, 207RR0500X
CA	G79073	207R00000X
CA	G77043	207R00000X
CA	G27664	207R00000X
CA	A49422	207R00000X, 207RR0500X
CA	G61346	207R00000X
CA	20A5403	207R00000X, 207RG0300X
CA	C33715	207R00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207RG0300X	Allopathic & Osteopathic Physicians	Internal Medicine	Geriatric Medicine	Group - Multi-Specialty
No	207RR0500X	Allopathic & Osteopathic Physicians	Internal Medicine	Rheumatology	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CA	00A494220	Medicaid
CA	00G613460	Medicaid
CA	020A54030	Medicaid
CA	00G276640	Medicaid
CA	00C337150	Medicaid
CA	00G790730	Medicaid
CA	00G770430	Medicaid
CA	F34555	Medicare UPIN
CA	E24902	Medicare UPIN
CA	A89457	Medicare UPIN
CA	G16981	Medicare UPIN
CA	00G276640	Medicaid
CA	G16339	Medicare UPIN
CA	020A54030	Medicaid
CA	00G790730	Medicaid
CA	00C337150	Medicaid
CA	00C243720	Medicare ID - Type Unspecified