Active NPI
David Roy Gilliam, M.D.
- Family Medicine Physician
- Fairfield, CA
National Provider Identifier
1376526236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- G36497
- Practice address
- 1620 Pennsylvannia Ave
Ste C
Fairfield, CA 94533-3509 - Phone
- (707) 428-4878
- Fax
- (707) 428-0806
- NPI assigned
- Nov 23, 2005
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G36497 | CA | Primary |
Addresses
Primary practice location
1620 Pennsylvannia Ave
Ste C
Fairfield, CA 94533-3509
Mailing address
1620 Pennsylvannia Ave
Ste C
Fairfield, CA 94533-3509
Phone (707) 428-4878
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 5, 2026 through Jan 5, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G36497 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403827200000",
"number": "1376526236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1620 PENNSYLVANNIA AVE",
"address_2": "STE C",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945333509",
"telephone_number": "707-428-4878",
"fax_number": "707-428-0806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1620 PENNSYLVANNIA AVE",
"address_2": "STE C",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945333509",
"telephone_number": "707-428-4878",
"fax_number": "707-428-0806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLIAM",
"first_name": "DAVID",
"middle_name": "ROY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-23",
"last_updated": "2014-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "G36497",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.