Active NPI
Geraldine M Dutra, P.A.
- Surgical Physician Assistant
- Woodland, CA
National Provider Identifier
1396917043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA14146
- Practice address
- 632 W Gibson Rd
Woodland, CA 95695-5169 - Phone
- (530) 668-2600
- NPI assigned
- Apr 1, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA14146 | CA | Primary |
Addresses
Primary practice location
632 W Gibson Rd
Woodland, CA 95695-5169
Mailing address
632 W Gibson Rd
Woodland, CA 95695-5169
Phone (530) 668-2600
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0079250 | Medicaid | CA | |
| ZZZ13239Z | Other | CA | GROUP PTAN |
| PA14146 | Other | CA | PA LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA14146 | CA | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthopedic Surgical Institute, Inc | Past | Accepting new patients | |
| Apogee Outpatient Surgery Center | Past | Accepting new patients | |
| Adam Freedhand MD Inc | Past | Accepting new patients |
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.
-
- Orthopaedic Surgery Physician
- Saint Helena, CA
- NPI 1245465608
-
- Ambulatory Surgical Clinic/Center
- Redding, CA
- NPI 1912094509
-
- Orthopaedic Surgery Physician
- Red Bluff, CA
- NPI 1871797860
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329177600000",
"number": "1396917043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "632 W GIBSON RD",
"city": "WOODLAND",
"state": "CA",
"postal_code": "956955169",
"telephone_number": "530-668-2600"
},
{
"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"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUTRA",
"first_name": "GERALDINE",
"middle_name": "M",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-01",
"last_updated": "2012-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "CA",
"license": "PA14146",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0079250",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP PTAN",
"identifier": "ZZZ13239Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA LICENSE",
"identifier": "PA14146",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.