Northern California Medical Assoc Inc

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

NORTHERN CALIFORNIA MEDICAL ASSOC INC

Practice address

1701 4TH St
Ste 120
Santa Rosa, CA 95404-3661

Phone

(707) 523-7025

Fax

(707) 523-3024

NPI assigned

Jan 25, 2011

Last updated

Nov 5, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Ruth A Skidmore

Title

Chief Executive Officer

Phone

(707) 525-6925

Specialties & licenses 4

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1295913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541376000000",
    "number": "1396040226",
    "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": "707-575-6049",
            "fax_number": "707-523-3024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 4TH ST",
            "address_2": "STE 120",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954043661",
            "telephone_number": "707-523-7025",
            "fax_number": "707-523-3024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN CALIFORNIA MEDICAL ASSOC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-25",
        "last_updated": "2018-11-05",
        "status": "A",
        "authorized_official_last_name": "SKIDMORE",
        "authorized_official_first_name": "RUTH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "707-525-6925",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396040226",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CN8040",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ38629Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northern California Medical Assoc Inc
• Northern California Medical Assoc Inc (Northern California Medical Associates, Inc.)
• Northern California Medical Assoc Inc
• Northern California Medical Assoc Inc
• Northern California Medical Assoc Inc
• Northern California Medical Assoc Inc
• Northern California Medical Assoc Inc
• Northern California Medical Assoc Inc
• Northern California Medical Assoc Inc
• Northern California Medical Assoc Inc (Northern California Medical Associates, Inc.)

• Otolaryngology Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Otolaryngology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2018; 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.