Active NPI
Donald Duane Vanfossan, M.D.
- Neurology Physician
- Jackson, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 00G577420
- Practice address
- 201 Clinton Rd
Suite 106
Jackson, CA 95642-2648 - Phone
- (209) 223-3021
- NPI assigned
- Nov 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 00G577420 | CA | Primary |
Addresses
Primary practice location
201 Clinton Rd
Suite 106
Jackson, CA 95642-2648
Mailing address
19200 Mountain View Way
Volcano, CA 95689-9707
Phone (209) 296-3163
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G577420 | Medicaid | CA |
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Neurology
- Education
- Saint Louis University School of Medicine, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
201 Clinton Rd
Jackson, CA 95642-2678
Phone (209) 223-3021
201 Clinton Rd
Suite 106
Jackson, CA 95642-2695
Hospital & facility affiliations
- Hospice of Amador & Calaveras
- Mark Twain Medical Center
- Sutter Amador Hospital
- Adventist Health Sonora
- Sutter Medical Center, Sacramento
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00G577420 | CA | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark Twain Medical Center | Current | Accepting new patients | |
| Sutter Valley Medical Foundation | Neurology | Current | Accepting new patients |
| Sutter Valley Medical Foundation | Current | Accepting new patients |
Locations
815 Court St
Ste 7
Jackson, CA 95642
Phone (209) 257-5900
12140 New York Ranch Rd
Jackson, CA 95642
Phone (209) 257-2400
2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850
704 Mountain Ranch Rd
Ste 102
San Andreas, CA 95249
Phone (209) 754-2968
702 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 754-0870
768 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 464-6422
700 Mountain Ranch Rd
Ste B
San Andreas, CA 95249
Phone (209) 754-9670
Interoperability endpoints
- dvanfossan113032@hisp.ehr.sutterhealth.org
Ownership & related parties
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Hospice of Amador & Calaveras | Hospice | Contracted Managing Employee | Jan 9, 2007 |
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Community Based Hospice Care Agency
- Jackson, CA
- NPI 1235111097
Contracted Managing Employee
Organizations & group practices 3
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.
-
- Critical Access Hospital
- San Andreas, CA
- NPI 1508968819
-
- Durable Medical Equipment & Medical Supplies
- Tracy, CA
- NPI 1720930712
Hospital & facility affiliations 16
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Community Based Hospice Care Agency
- Jackson, CA
- NPI 1235111097
-
- Critical Access Hospital
- San Andreas, CA
- NPI 1508968819
-
- General Acute Care Hospital
- Sonora, CA
- NPI 1780673376
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336219930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19200 MOUNTAIN VIEW WAY",
"city": "VOLCANO",
"state": "CA",
"postal_code": "956899707",
"telephone_number": "209-296-3163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 CLINTON RD",
"address_2": "SUITE 106",
"city": "JACKSON",
"state": "CA",
"postal_code": "956422648",
"telephone_number": "209-223-3021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANFOSSAN",
"first_name": "DONALD",
"middle_name": "DUANE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "CA",
"license": "00G577420",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G577420",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.