NPIMap

Organization Active NPI

Providence Medical Foundation

  • Family Medicine Physician
  • Santa Rosa, CA
National Provider Identifier
1265015978
Registry record updated Jan 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PROVIDENCE MEDICAL FOUNDATION
Practice address
185 Sotoyome St
Santa Rosa, CA 95405-4803
Phone
(707) 303-8355
Fax
(707) 303-2035
NPI assigned
Apr 30, 2021
Last updated
Jan 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2026

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

Authorized official

Name
Donald W. Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

185 Sotoyome St
Santa Rosa, CA 95405-4803

Mailing address

PO Box 31001 - 1920
Pasadena, CA 91110-1920
Phone (707) 303-8355

Other names 1

  • Providence Medical Group Northern California Other name

National Provider Directory

National Provider Directory
Tax ID family
St Jude Hertiage Health44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Locations

185 Sotoyome St
Santa Rosa, CA 95405
Phone (707) 303-1709

NPI Registry JSON

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

{
    "created_epoch": "1619740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767657600000",
    "number": "1265015978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001 - 1920",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911101920",
            "telephone_number": "707-303-8355",
            "fax_number": "707-303-2035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 SOTOYOME ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054803",
            "telephone_number": "707-303-8355",
            "fax_number": "707-303-2035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-30",
        "last_updated": "2026-01-06",
        "certification_date": "2026-01-06",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Medical Group Northern California",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.