Individual provider Active NPI

Kelly Jo Doerzbacher, M.D.

  • Anesthesiology Physician
  • Davis, CA
National Provider Identifier
1467522482
Registry record updated Jul 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A106787 Issued in CA
Practice address
2000 Sutter PL
Davis, CA 95616-6201
Phone
(707) 330-8191
NPI assigned
Nov 8, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A106787 CA Primary

Addresses

Primary practice location

2000 Sutter PL
Davis, CA 95616-6201

Mailing address

10470 Old Placerville Rd
Suite 100
Sacramento, CA 95827-2539
Phone (800) 470-0071

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090930000559 CA Practitioner - Anesthesiology 4385780659 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Pennsylvania State University College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America - Anesthesia PCGroup PAC ID 3678897915, 849 clinicians

Practice addresses (Care Compare)

975 S Fairmont Ave
Lodi, CA 95240-5118
Phone (209) 334-3411

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A106787CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - Anesthesia PC Anesthesiology CurrentSince Sep 1, 2018 Accepting new patients
Cep America - Anesthesia PC Anesthesiology CurrentSince Sep 1, 2018 Accepting new patients
Cep America - Anesthesia, PC Anesthesiology Current Accepting new patients
Cep America - Anesthesia PC Anesthesiology Past Accepting new patients

Locations

8135 Saratoga Way
El Dorado Hls, CA 95762
Phone (815) 997-2939

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

975 S Fairmont Ave
Lodi, CA 95240
Phone (209) 339-7575

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

2550 Sister Mary Columba Dr
Red Bluff, CA 96080
Phone (530) 529-8000

2175 Rosaline Ave
Ste A
Redding, CA 96001
Phone (530) 225-7400

2175 Rosaline Ave
Redding, CA 96001
Phone (530) 225-7247

4001 J St
Sacramento, CA 95819
Phone (916) 453-4037

525 W Acacia St
Stockton, CA 95203
Phone (209) 944-5410

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436313600000",
    "number": "1467522482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10470 OLD PLACERVILLE RD",
            "address_2": "SUITE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272539",
            "telephone_number": "800-470-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 SUTTER PL",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956166201",
            "telephone_number": "707-330-8191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOERZBACHER",
        "first_name": "KELLY",
        "middle_name": "JO",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2015-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A106787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davis, CA

Sources for this page

Verify at the official NPI Registry.