Sean Michael Dougherty, D.P.M.

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

E5009 Issued in CA

Practice address

1620 Pennsylvania Ave Ste a
Fairfield, CA 94533-3509

Phone

(707) 426-5644

Fax

(707) 426-3156

NPI assigned

Aug 27, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jiva Health IncGroup PAC ID 5092115105, 46 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northbay Medical Center Hospital, Fairfield, CA, CCN 050367

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sdougherty44352@hpmg.direct-ci.net

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.

• Jiva Health, Inc

  • Internal Medicine Physician
  • Concord, CA
  • NPI 1285223552

  Podiatrist

  Medicare reassignment Care Compare group NPD
• Allergy Consultants Medical Group Inc

  • Allergy Physician
  • Castro Valley, CA
  • NPI 1255399473
  NPD (past)
• Northbay Healthcare Group

  • General Acute Care Hospital
  • Fairfield, CA
  • NPI 1821147786
  NPD (past)
• Tri-Valley Orthopedic and Sports Medical Group Inc

  • Orthopaedic Surgery Physician
  • Pleasanton, CA
  • NPI 1184808156
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northbay Healthcare Group

  • General Acute Care Hospital
  • Fairfield, CA
  • NPI 1821147786
  Care Compare affiliation

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

{
    "created_epoch": "1251331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1407089261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 PENNSYLVANIA AVE STE A",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945333509",
            "telephone_number": "707-426-5644",
            "fax_number": "707-426-3156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 PENNSYLVANIA AVE STE A",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945333509",
            "telephone_number": "707-426-5644",
            "fax_number": "707-426-3156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "SEAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-27",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E5009",
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "CA",
            "license": "E5009",
            "primary": false
        },
        {
            "code": "213ES0000X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Sports Medicine",
            "state": "CA",
            "license": "E5009",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E5009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P01083197",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kalsang Dolker Dorji, DNP, FNP-BC
• Rhonda Cole Dorsey, RN, BSN, PHN
• Rajinder Singh Dosanjh
• Rokzanne Dosier, FNP-C, RNFA
• Meghan Dotta
• Angellique Douglas
• Michel Douglas
• Kimberly Douglass
• Heather Doumbia
• Moktar Michael Doumbia

• Foot & Ankle Surgery Podiatrist in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Foot & Ankle Surgery Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.