NPIMap

Organization Active NPI

Northern California Medical Assoc Inc

  • Dermatology Physician
  • Ukiah, CA
National Provider Identifier
1275945958
Registry record updated May 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
NORTHERN CALIFORNIA MEDICAL ASSOC INC
Practice address
1165 South Dora St
Ste G2
Ukiah, CA 95482-6353
Phone
(707) 462-2960
Fax
(707) 462-2756
NPI assigned
May 29, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2014

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

Authorized official

Name
Ruth Ann Skidmore
Title
Chief Executive Officer
Phone
(707) 573-6925

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X CA Primary

Addresses

Primary practice location

1165 South Dora St
Ste G2
Ukiah, CA 95482-6353

Mailing address

3536 Mendocino Ave
Ste 200
Santa Rosa, CA 95403-3634
Phone (707) 525-6485

National Provider Directory

National Provider Directory
Tax ID family
Northern California Medical Assoc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401321600000",
    "number": "1275945958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3536 MENDOCINO AVE",
            "address_2": "STE 200",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033634",
            "telephone_number": "707-525-6485",
            "fax_number": "707-573-6918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1165 SOUTH DORA ST",
            "address_2": "STE G2",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954826353",
            "telephone_number": "707-462-2960",
            "fax_number": "707-462-2756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN CALIFORNIA MEDICAL ASSOC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-29",
        "last_updated": "2014-05-29",
        "status": "A",
        "authorized_official_last_name": "SKIDMORE",
        "authorized_official_first_name": "RUTH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "707-573-6925"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ukiah, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2014; 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.