NPIMap

Individual provider Active NPI

Mignonette Mae Willkom, MD

  • Family Medicine Physician
  • Livermore, CA
National Provider Identifier
1003883133
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A53664 Issued in CA
Practice address
1133 E Stanley Blvd Ste 101
Livermore, CA 94550-4270
Phone
(925) 454-4280
NPI assigned
Mar 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A53664 CA Primary

Addresses

Primary practice location

1133 E Stanley Blvd Ste 101
Livermore, CA 94550-4270

Mailing address

1133 E Stanley Blvd Ste 101
Livermore, CA 94550-4270
Phone (925) 454-4280

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040609000657 CA Practitioner - Family Practice 8820071186 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Healthcare AllianceGroup PAC ID 6305748799, 334 clinicians

Practice addresses (Care Compare)

1133 E Stanley Blvd
Suite 203
Livermore, CA 94550-4246
Phone (925) 443-1311

Hospital & facility affiliations

  • St. Jude Home Health Agency Home health agency, Pleasanton, CA, CCN 059495
  • Comfort Assisting, Inc Home health agency, Walnut Creek, CA, CCN 059537
  • A1 Pro Home Health Inc. Home health agency, San Leandro, CA, CCN 757933
  • Stanford Health Care Tri-Valley Hospital, Pleasanton, CA, CCN 050283
  • Stanford Health Care Hospital, Stanford, CA, CCN 050441

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
University Healthcare Alliance CurrentSince Jul 11, 2016 Accepting new patients
Livermore Primary Care Medical Associates, Inc. Family Medicine PastSince Jun 1, 2004 Accepting new patients
Stanford Health Care Tri-Valley Past Accepting new patients
Stanford Hospital and Clinics Past Accepting new patients
Affinity Medical Group Past Accepting new patients
The Hospital Committee for the Livermore-Pleasanton Areas Past Accepting new patients

Locations

1133 E Stanley Blvd
Ste 203
Livermore, CA 94550
Phone (925) 373-4129

1133 E Stanley Blvd
Ste 101
Livermore, CA 94550
Phone (925) 454-4280

1300 Crane St
Menlo Park, CA 94025
Phone (510) 785-5000

5575 W Las Positas Blvd
Ste 130
Pleasanton, CA 94588
Phone (925) 463-0395

4725 1st St
Ste 100
Pleasanton, CA 94566
Phone (925) 462-7060

Interoperability endpoints

  • Direct secure messaging: mwillkom164539@direct.stanfordhealthcare.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1003883133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 E STANLEY BLVD STE 101",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945504270",
            "telephone_number": "925-454-4280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 E STANLEY BLVD STE 101",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945504270",
            "telephone_number": "925-454-4280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLKOM",
        "first_name": "MIGNONETTE",
        "middle_name": "MAE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-07",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A53664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livermore, CA

Sources for this page

Verify at the official NPI Registry.