Active NPI
Diana Marie Madison, PA
- Physician Assistant
- Healdsburg, CA
National Provider Identifier
1083600332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA12122
- Practice address
- 1381 University St
Healdsburg, CA 95448-3314 - Phone
- (707) 431-8234
- Fax
- (707) 431-1427
- NPI assigned
- Sep 22, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA12122 | CA | Primary |
Addresses
Primary practice location
1381 University St
Healdsburg, CA 95448-3314
Mailing address
1381 University St
Healdsburg, CA 95448-3314
Phone (707) 431-8234
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12122 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| PA12122 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324339200000",
"number": "1083600332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1381 UNIVERSITY ST",
"city": "HEALDSBURG",
"state": "CA",
"postal_code": "954483314",
"telephone_number": "707-431-8234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1381 UNIVERSITY ST",
"city": "HEALDSBURG",
"state": "CA",
"postal_code": "954483314",
"telephone_number": "707-431-8234",
"fax_number": "707-431-1427"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADISON",
"first_name": "DIANA",
"middle_name": "MARIE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-22",
"last_updated": "2011-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA12122",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Healdsburg, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.