Active NPI
William M Griffin, M.D.
- Specialist
- Jackson, CA
National Provider Identifier
1417095183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- G65062
- Practice address
- 200 Mission Blvd
Jackson, CA 95642-2564 - Phone
- (209) 223-0949
- Fax
- (209) 223-0965
- NPI assigned
- Feb 2, 2007
- Last updated
- Dec 18, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | G65062 | CA | Primary |
Addresses
Primary practice location
200 Mission Blvd
Jackson, CA 95642-2564
Mailing address
PO Box 877
Jackson, CA 95642-0877
Phone (209) 223-0949
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GROO43480 | Medicaid | CA |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65062 | CA | MD | Oral and Maxillofacial Surgery (Dentist) |
| G65062 | CA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mother Lode Diagnostic Imaging Inc | Specialist | Past | Accepting new patients |
| Radiologica Inc. | Past | Accepting new patients | |
| Advanced Medical Imaging Inc | Past | Accepting new patients | |
| Mark Twain Medical Center | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- NPI 1053456061
Specialist
-
- Diagnostic Radiology Physician
- San Andreas, CA
- NPI 1073000105
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197936000000",
"number": "1417095183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 877",
"city": "JACKSON",
"state": "CA",
"postal_code": "956420877",
"telephone_number": "209-223-0949",
"fax_number": "209-223-0965"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MISSION BLVD",
"city": "JACKSON",
"state": "CA",
"postal_code": "956422564",
"telephone_number": "209-223-0949",
"fax_number": "209-223-0965"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIFFIN",
"first_name": "WILLIAM",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2007-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "G65062",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GROO43480",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.