NPIMap

Individual provider Active NPI

Marcelle Mahan, M.D.

  • General Practice Physician
  • Eureka, CA
National Provider Identifier
1245292085
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
G078160 Issued in CA
Practice address
2700 Dolbeer St
Eureka, CA 95501-4736
Phone
(707) 269-4250
NPI assigned
Apr 5, 2006
Last updated
Mar 29, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X G71860 CA
General Practice Physician 208D00000X G078160 CA Primary

Addresses

Primary practice location

2700 Dolbeer St
Eureka, CA 95501-4736

Mailing address

PO Box 2717
McKinleyville, CA 95519-2717
Phone (707) 499-8781

Other identifiers 1

IdentifierTypeStateIssuer
00G718600MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address marcellemahan@sjhhandhmg.allscriptsdirect.net

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
I20050107000577 CA Practitioner - Family Practice 6608824453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loma Linda University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

2280 Harrison Ave
Suite B
Eureka, CA 95501-3200
Phone (707) 443-9371

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions41
Removal of nail tissue1-10
Removal or shaving of skin growth13

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G71860CAMDEmergency Medicine Physician
G078160CAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation General Practice Current Accepting new patients
Providence Medical Foundation CurrentSince Feb 3, 2020 Accepting new patients
Providence Medical Foundation CurrentSince Feb 3, 2020 Accepting new patients
American Hospital Management Corporation Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Ann Lindsay MD and Alan Glaseroff MD Past Accepting new patients
Providence Medical Foundation General Practice Past Accepting new patients

Locations

2280 Harrison Ave
Ste B
Eureka, CA 95501
Phone (707) 443-9371

2700 Dolbeer St
Eureka, CA 95501
Phone (707) 269-4229

3200 Walford Ave
Ste E
Eureka, CA 95503
Phone (707) 441-8335

3300 Renner Dr
Fortuna, CA 95540
Phone (707) 725-3361

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

Organizations & group practices 7

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 6

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": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1245292085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2717",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955192717",
            "telephone_number": "707-499-8781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 DOLBEER ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955014736",
            "telephone_number": "707-269-4250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHAN",
        "first_name": "MARCELLE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-05",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G71860",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "G078160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G718600",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "marcellemahan@sjhhandhmg.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "2700 Dolbeer St",
            "city": "Eureka",
            "state": "CA",
            "country_code": "US",
            "postal_code": "955014736",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Eureka, CA

Sources for this page

Verify at the official NPI Registry.