Individual provider Active NPI

John Woodcock, DO

  • Family Medicine Physician
  • Palmdale, CA
National Provider Identifier
1063452316
Registry record updated Jan 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A6801 Issued in CA
Practice address
39115 Trade Center Dr
Palmdale, CA 93551-3649
Phone
(661) 273-0100
Fax
(661) 273-5812
NPI assigned
Jun 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2012

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 20A6801 CA Primary

Addresses

Primary practice location

39115 Trade Center Dr
Palmdale, CA 93551-3649

Mailing address

44469 10TH St West
Lancaster, CA 93534
Phone (661) 945-9411

Other identifiers 1

IdentifierTypeStateIssuer
0020A68010MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090619000162 CA Practitioner - Family Practice 4981755600 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sierra Medical Group Holding Company, Inc.Group PAC ID 9335185594, 9 clinicians

Practice addresses (Care Compare)

39115 Trade Ctr Dr
Palmdale, CA 93551-3649
Phone (661) 273-0100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A6801CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sierra Medical Group Holding Company, Inc. Family Medicine CurrentSince Apr 14, 2009 Accepting new patients
Antelope Valley Health Care District Past Accepting new patients
Radadvantage a Professional Corporation PastSince Apr 14, 2009 Accepting new patients

Locations

44469 10th St W
Lancaster, CA 93534
Phone (661) 945-9411

39115 Trade Center Dr
Palmdale, CA 93551
Phone (661) 223-3880

38636 Medical Center Dr
Ste D
Palmdale, CA 93551

38636 Medical Center Dr
Ste E
Palmdale, CA 93551
Phone (661) 265-7000

38636 Medical Center Dr
Ste C
Palmdale, CA 93551
Phone (661) 273-0100

39115 Trade Center Dr
Ste 130
Palmdale, CA 93551
Phone (661) 273-0100

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326412800000",
    "number": "1063452316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44469 10TH ST WEST",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "93534",
            "telephone_number": "661-945-9411",
            "fax_number": "661-945-7115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39115 TRADE CENTER DR",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935513649",
            "telephone_number": "661-273-0100",
            "fax_number": "661-273-5812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODCOCK",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2012-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A6801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0020A68010",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palmdale, CA

Sources for this page

Verify at the official NPI Registry.