Individual provider Active NPI

Christie Lyn Carroll, MD

  • Dermatology Physician
  • Woodland, CA
National Provider Identifier
1366580532
Registry record updated Oct 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A97679 Issued in CA
Practice address
632 W Gibson Rd
Woodland, CA 95695-5169
Phone
(530) 668-2600
Fax
(530) 669-3638
NPI assigned
Feb 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X A97679 CA Primary

Addresses

Primary practice location

632 W Gibson Rd
Woodland, CA 95695-5169

Mailing address

3400 Data Dr
Attn: Credentialing/Payer Enrollment
Rancho Corcova, CA 95670-7956

Other names 1

  • Ms. Christie L Thompson Former name

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
I20070726000287 CA Practitioner - Dermatology 5193826766 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of California, Davis School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dignity Health Medical FoundationGroup PAC ID 7810800661, 1,211 clinicians

Practice addresses (Care Compare)

2440 W Covell Blvd
Suite 100
Davis, CA 95616-5671
Phone (530) 668-2600

632 W Gibson Rd
Woodland, CA 95695-5169
Phone (530) 668-2600

Hospital & facility affiliations

  • Mercy General Hospital Hospital, Sacramento, CA, CCN 050017

Merit-based Incentive Payment System (MIPS)

Final score
99.64 of 100Reported as apm
Quality
86.27
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1191
Removal or shaving of skin growth31
Skin biopsy109

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A97679CAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health Medical Foundation CurrentSince Mar 16, 2021 Accepting new patients
CHW Medical Foundation CurrentSince Jul 25, 2007 Accepting new patients
Dignity Health Medical Foundation Current Accepting new patients
Dignity Community Care Past Accepting new patients

Locations

2440 W Covell Blvd
Ste 100
Davis, CA 95616
Phone (530) 668-2600

3400 Data Dr
Fl 1
Rancho Cordova, CA 95670
Phone (916) 379-2726

3400 Data Dr
Rncho Cordova, CA 95670
Phone (916) 379-2726

2081 Bronze Star Dr
Woodland, CA 95776
Phone (530) 668-2600

632 W Gibson Rd
Woodland, CA 95695
Phone (530) 666-1631

1207 Fairchild Ct
Woodland, CA 95695
Phone (530) 406-2900

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 1

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": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1366580532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DATA DR",
            "address_2": "ATTN: CREDENTIALING/PAYER ENROLLMENT",
            "city": "RANCHO CORCOVA",
            "state": "CA",
            "postal_code": "956707956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "632 W GIBSON RD",
            "city": "WOODLAND",
            "state": "CA",
            "postal_code": "956955169",
            "telephone_number": "530-668-2600",
            "fax_number": "530-669-3638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "CHRISTIE",
        "middle_name": "LYN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-01",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A97679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTIE",
            "last_name": "THOMPSON",
            "middle_name": "L",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Woodland, CA

Sources for this page

Verify at the official NPI Registry.