NPIMap

Individual provider Active NPI

Kathleen Ellen Whisman, M.D.

  • Family Medicine Physician
  • Sebastopol, CA
National Provider Identifier
1124179353
Registry record updated Jul 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G79463 Issued in CA
Practice address
678 Petaluma Ave
Sebastopol, CA 95472-4217
Phone
(707) 823-6997
Fax
(707) 829-3709
NPI assigned
Jan 15, 2007
Last updated
Jul 20, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 20, 2021

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 G79463 CA Primary

Addresses

Primary practice location

678 Petaluma Ave
Sebastopol, CA 95472-4217

Mailing address

678 Petaluma Ave
Sebastopol, CA 95472-4217
Phone (707) 694-2390

Other identifiers 1

IdentifierTypeStateIssuer
00G794630MedicaidCA

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
I20090805000362 CA Practitioner - Family Practice 5092868240 Reassigns benefits to 2 organizations
Practice locations: Sebastopol, CA

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
George Washington University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

678 Petaluma Ave
Sebastopol, CA 95472-4217
Phone (707) 508-8191

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.9 of 100Reported as group
Quality
81.89
Promoting interoperability
99
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G79463CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sebastopol Urgent Care CurrentSince Aug 17, 2021 Accepting new patients
Sutter Bay Medical Foundation PastSince Jul 25, 2021 Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Alameda Health System Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients

Locations

555 Petaluma Ave
Ste B
Sebastopol, CA 95472
Phone (707) 823-7602

555 Petaluma Ave
Ste B2
Sebastopol, CA 95472
Phone (707) 239-9257

Interoperability endpoints

  • Direct secure messaging: kathleen.whisman@356018393055236.direct.elationemr.com
  • Direct secure messaging: kathleen.whisman@359951357313028.direct.elationemr.com
  • Direct secure messaging: kwhisman@yourcarecommunity.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1124179353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "678 PETALUMA AVE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724217",
            "telephone_number": "707-694-2390",
            "fax_number": "707-829-3709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "678 PETALUMA AVE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724217",
            "telephone_number": "707-823-6997",
            "fax_number": "707-829-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHISMAN",
        "first_name": "KATHLEEN",
        "middle_name": "ELLEN",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G79463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G794630",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sebastopol, CA

Sources for this page

Verify at the official NPI Registry.