MEDICARE: CAPITOL CITY MEDICAL GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center
2	2471B0102X	Bone Densitometry Radiologic Technologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ZZZ61216Z	OTHER	CA	BLUE SHIELD PROVIDER ID

General Provider Information

NPI Number	:	1447238092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITOL CITY MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	500 UNIVERSITY AVE
Second Line	:	SUITE 200
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-6523
Country	:	US
Telephone Number	:	916-920-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 UNIVERSITY AVE
Second Line	:	SUITE 200
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-6523
Country	:	US
Telephone Number	:	916-920-1200
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ROSE MARY ULLERY
Credential	:
Telephone Number	:	916-920-1200

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	09/11/2025

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Directions to “CAPITOL CITY MEDICAL GROUP, INC ” Practice Location

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