| Prime Health Llc | |
|
900 E Main St Ste 106 Grass Valley CA 95945-5853 | |
| (747) 500-4253 | |
| Not Available |
| Full Name | Prime Health Llc |
|---|---|
| Speciality | General Practice |
| Location | 900 E Main St Ste 106, Grass Valley, California |
| Authorized Official Name and Position | Kelly Powell (OWNER/ PHYSICIAN) |
| Authorized Official Contact | 7475004253 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Health Llc 900 E Main St Ste 106 Grass Valley CA 95945-5853 Ph: (747) 500-4253 | Prime Health Llc 900 E Main St Ste 106 Grass Valley CA 95945-5853 Ph: (747) 500-4253 |
| NPI Number | 1568174118 |
|---|---|
| Provider Enumeration Date | 12/14/2022 |
| Last Update Date | 10/01/2025 |
| Medicare PECOS PAC ID | 8729457742 |
|---|---|
| Medicare Enrollment ID | O20221214002867 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568174118 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Kelly Stephen Powell |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1821442666 PECOS PAC ID: 4082909338 Enrollment ID: I20210629001983 |
| Provider Name | Joseph Neal Hiatt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942982426 PECOS PAC ID: 0446600993 Enrollment ID: I20231222002567 |
| Provider Name | Ian Webster Radloff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932940319 PECOS PAC ID: 9537699939 Enrollment ID: I20250214001904 |
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