Individual provider Active NPI

Donald J Iverson, MD

  • Neurology Physician
  • Eureka, CA
National Provider Identifier
1356309728
Registry record updated Nov 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
G60800 Issued in CA
Practice address
2828 Oneil Lane
Eureka, CA 95503-4870
Phone
(707) 443-9385
Fax
(707) 443-0258
NPI assigned
May 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X G60800 CA Primary

Addresses

Primary practice location

2828 Oneil Lane
Eureka, CA 95503-4870

Mailing address

2828 Oneil Lane
Eureka, CA 95503-4870
Phone (707) 443-9385

Other identifiers 3

IdentifierTypeStateIssuer
00G608000MedicaidCA
0165084OtherWADEPF OF LABOR & INDUSTRIE
130004938OtherRAILROAD MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address diverson1657840@oc.providencedirect.org

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100510000266 CA Practitioner - Neurology 3173694163 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of California, Geffen School of Medicine, 1985
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)

200 W Ctr St Promenade
Anaheim, CA 92805-3960

2700 Dolbeer St
Eureka, CA 95501-4736
Phone (707) 445-8121

2710 Dolbeer St
Eureka, CA 95501-4736
Phone (707) 267-2060

2773 Harris St
Eureka, CA 95503-4866

2828 Oneil LN
Eureka, CA 95503-4870
Phone (707) 443-9385

500 Doyle Park Dr
Santa Rosa, CA 95405-4559

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G60800CAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Jan 22, 2018 Accepting new patients
Providence Medical Foundation CurrentSince Jan 22, 2018 Accepting new patients

Locations

2828 Oneil Ln
Eureka, CA 95503
Phone (707) 443-9385

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

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

Organizations & group practices 4

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.

Hospital & facility affiliations 8

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": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1356309728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2828 ONEIL LANE",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955034870",
            "telephone_number": "707-443-9385",
            "fax_number": "707-443-0258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2828 ONEIL LANE",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955034870",
            "telephone_number": "707-443-9385",
            "fax_number": "707-443-0258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVERSON",
        "first_name": "DONALD",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "G60800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G608000",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPF OF LABOR & INDUSTRIE",
            "identifier": "0165084",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "130004938",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "diverson1657840@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "2828 ONeil Lane",
            "city": "Eureka",
            "state": "CA",
            "country_code": "US",
            "postal_code": "955034870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Eureka, CA

Sources for this page

Verify at the official NPI Registry.