Organization Active NPI

Gary Wikholm M D a Professional Corporation

  • Family Medicine Physician
  • Santa Paula, CA
National Provider Identifier
1053417725
Registry record updated Jan 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GARY WIKHOLM M D A PROFESSIONAL CORPORATION
Practice address
247 W Harvard Blvd
Santa Paula, CA 93060-3223
Phone
(805) 525-0907
Fax
(805) 933-3392
NPI assigned
Sep 16, 2006
Last updated
Jan 28, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2026

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

Authorized official

Name
Ms. Agi Kessler
Title
Manager
Phone
(805) 525-0907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

247 W Harvard Blvd
Santa Paula, CA 93060-3223

Mailing address

247 W Harvard Blvd
Santa Paula, CA 93060-3223
Phone (805) 525-0907

Other identifiers 1

IdentifierTypeStateIssuer
GR0085000MedicaidCA

Other names 1

  • GARY WIKHOLM M D Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050714000657 CA Part B Supplier - Clinic/Group Practice 2769418334 Receives reassigned benefits from 2 practitioners
Practice locations: Santa Paula, CA

National Provider Directory

National Provider Directory

Locations

539 Sespe Ave
Fillmore, CA 93015
Phone (805) 525-0907

247 W Harvard Blvd
Santa Paula, CA 93060
Phone (805) 525-0907

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769558400000",
    "number": "1053417725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 W HARVARD BLVD",
            "city": "SANTA PAULA",
            "state": "CA",
            "postal_code": "930603223",
            "telephone_number": "805-525-0907",
            "fax_number": "805-933-3392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 W HARVARD BLVD",
            "city": "SANTA PAULA",
            "state": "CA",
            "postal_code": "930603223",
            "telephone_number": "805-525-0907",
            "fax_number": "805-933-3392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY WIKHOLM M D A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2026-01-28",
        "certification_date": "2026-01-28",
        "status": "A",
        "authorized_official_last_name": "KESSLER",
        "authorized_official_first_name": "AGI",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "805-525-0907",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0085000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GARY WIKHOLM M D",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Santa Paula, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.