Active NPI
Gidon Levenbach, MACOM
- Acupuncturist
- Santa Rosa, CA
National Provider Identifier
1407306996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC 16831
- Practice address
- 1970 Knolls Dr
Santa Rosa, CA 95405-8305 - Phone
- (805) 298-3580
- NPI assigned
- Oct 7, 2016
- 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 |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC 16831 | CA | Primary |
Addresses
Primary practice location
1970 Knolls Dr
Santa Rosa, CA 95405-8305
Mailing address
1970 Knolls Dr
Santa Rosa, CA 95405-8305
Phone (805) 298-3580
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC 16831 | CA | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alliance Medical Center | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Federally Qualified Health Center (FQHC)
- Healdsburg, CA
- NPI 1750399796
Single Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475798400000",
"number": "1407306996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1970 KNOLLS DR",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954058305",
"telephone_number": "805-298-3580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1970 KNOLLS DR",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954058305",
"telephone_number": "805-298-3580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEVENBACH",
"first_name": "GIDON",
"name_prefix": "Mr.",
"credential": "MACOM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-10-07",
"last_updated": "2016-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Acupuncturist",
"state": "CA",
"license": "AC 16831",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.