Individual provider Active NPI

Jill Hutton Davidson, NP

  • Family Nurse Practitioner
  • Santa Rosa, CA
National Provider Identifier
1265211155
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95027431 Issued in CA
Practice address
1300 N Dutton Ave
Santa Rosa, CA 95401-7112
Phone
(707) 303-3600
NPI assigned
Sep 28, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95027431 CA Primary

Addresses

Primary practice location

1300 N Dutton Ave
Santa Rosa, CA 95401-7112

Mailing address

1025 King St
Santa Rosa, CA 95404-3402
Phone (207) 808-9507

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240429000575 CA Practitioner - Nurse Practitioner 3779923446 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95027431CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Santa Rosa Community Health Centers CurrentSince Feb 11, 2024 Accepting new patients
Santa Rosa Community Health Centers Current Accepting new patients

Locations

3569 Round Barn Cir
Santa Rosa, CA 95403

1300 N Dutton Ave
Santa Rosa, CA 95401
Phone (707) 303-3395

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1695859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1265211155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 KING ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954043402",
            "telephone_number": "207-808-9507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N DUTTON AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954017112",
            "telephone_number": "707-303-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "JILL",
        "middle_name": "HUTTON",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-28",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95027431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.