Individual provider Active NPI

Elizabeth Suzanne Culhane, M.D.

  • Pediatrics Physician
  • Santa Rosa, CA
National Provider Identifier
1508979923
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
G74888 Issued in CA
Practice address
500 Doyle Park Dr
Suite 100
Santa Rosa, CA 95405-4558
Phone
(707) 544-6090
Fax
(707) 544-2389
NPI assigned
Aug 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X G74888 CA Primary

Addresses

Primary practice location

500 Doyle Park Dr
Suite 100
Santa Rosa, CA 95405-4558

Mailing address

500 Doyle Park Dr
Suite 100
Santa Rosa, CA 95405-4558
Phone (707) 544-6090

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eculhane1657594@oc.providencedirect.org

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
I20120828000461 CA Practitioner - Pediatric Medicine 3274780135 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Rush Medical College of Rush University, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

1165 Montgomery Dr
Santa Rosa, CA 95405-4801
Phone (707) 546-3210

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
74888CAMDPharmacist
G74888CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Jul 17, 2012 Accepting new patients
Providence Medical Foundation CurrentSince Jul 17, 2012 Accepting new patients
Providence Medical Foundation Current Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 400
Anaheim, CA 92805

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

1165 Montgomery Dr
Santa Rosa, CA 95405
Phone (707) 525-5300

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

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.

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1508979923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 DOYLE PARK DR",
            "address_2": "SUITE 100",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054558",
            "telephone_number": "707-544-6090",
            "fax_number": "707-544-2389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 DOYLE PARK DR",
            "address_2": "SUITE 100",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054558",
            "telephone_number": "707-544-6090",
            "fax_number": "707-544-2389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULHANE",
        "first_name": "ELIZABETH",
        "middle_name": "SUZANNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-17",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G74888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eculhane1657594@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "500 Doyle Park Dr",
            "address_2": "Suite 100",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954054558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.