Douglas Peter Davidson Jr., PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

62399 Issued in CA

Practice address

50 Acacia Ave
San Rafael, CA 94901-2230

Phone

(951) 816-8970

NPI assigned

Sep 22, 2021

Reactivated

Dec 5, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clinic Services of California Medical Group IncGroup PAC ID 7810209715, 65 clinicians

Dignity Health Medical FoundationGroup PAC ID 7810800661, 1,211 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Lodi Memorial Hospital, Lodi, CA, CCN 050336
• Woodland Memorial Hospital Hospital, Woodland, CA, CCN 050127

Merit-based Incentive Payment System (MIPS)

Final score

96.69 of 100Reported as group

Quality

90

Improvement activities

40

Cost

78.43

Merit-based Incentive Payment System (MIPS)

Final score

99.64 of 100Reported as apm

Quality

86.27

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Clinic Services of California Medical Group Inc

  • Emergency Medicine Physician
  • Lodi, CA
  • NPI 1578958450
  Medicare reassignment Care Compare group
• Dignity Health Medical Foundation

  • Multi-Specialty Clinic/Center
  • Sacramento, CA
  • NPI 1700803418
  Medicare reassignment Care Compare group
• Cep America - California

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1023063542
  Medicare reassignment
• Team Physicians of California Medical Group Inc

  • Emergency Medicine Physician
  • Delano, CA
  • NPI 1447288345
  Medicare reassignment
• Cep America-California

  • Emergency Medicine Physician
  • Tracy, CA
  • NPI 1629814736
  NPD
• Dignity Health Medical Foundation

  • Multi-Specialty Clinic/Center
  • Woodland, CA
  • NPI 1144497678
  NPD

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

• Dignity Community Care

  • General Acute Care Hospital
  • Woodland, CA
  • NPI 1922116037
  Care Compare affiliation
• Lodi Memorial Hospital Association Inc

  • General Acute Care Hospital
  • Lodi, CA
  • NPI 1316938301
  Care Compare affiliation

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

{
    "created_epoch": "1632268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1174294938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38332 MAPLE CT",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925623406",
            "telephone_number": "951-816-8970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 ACACIA AVE",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012230",
            "telephone_number": "951-816-8970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "DOUGLAS",
        "middle_name": "PETER",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-22",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "deactivation_date": "2022-02-26",
        "reactivation_date": "2022-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "62399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darron R Rishwain DDS Inc
• Jennifer Daughrity
• David M Tully Smith M D a Medical Corporation
• David Talamo, MFT
• John E. David, MD
• Geeta Ann Davidson, M.S.
• Natalie Fay Davidson, MFT
• Seren Cari Davies-Hughes
• Valerie R Davis-Rucker
• Neomi Davis-Welch

• Physician Assistant in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.