Active NPI
Northern California Medical Assoc Inc
- Pulmonary Disease Physician
- Ukiah, CA
National Provider Identifier
1598067720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- Legal business name
- NORTHERN CALIFORNIA MEDICAL ASSOC INC
- Practice address
- 620 S Dora St
Ste 102 West
Ukiah, CA 95482-5466 - Phone
- (707) 462-1516
- Fax
- (707) 462-1178
- NPI assigned
- Nov 19, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Ruth A Skidmore
- Title
- Chief Executive Officer
- Phone
- (707) 573-6925
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | |||
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | |||
| Pulmonary Disease Physician | 207RP1001X | Primary | ||
| Sleep Medicine (Internal Medicine) Physician | 207RS0012X |
Addresses
Primary practice location
620 S Dora St
Ste 102 West
Ukiah, CA 95482-5466
Mailing address
3536 Mendocino Ave
Ste 200
Santa Rosa, CA 95403-3634
Phone (707) 575-6049
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598067720 | Medicaid | CA | |
| ZZZ03529Z | Other | CA | BLUE SHIELD |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1290124800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1328745600000",
"number": "1598067720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3536 MENDOCINO AVE",
"address_2": "STE 200",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954033634",
"telephone_number": "707-575-6049",
"fax_number": "707-573-6918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 S DORA ST",
"address_2": "STE 102 WEST",
"city": "UKIAH",
"state": "CA",
"postal_code": "954825466",
"telephone_number": "707-462-1516",
"fax_number": "707-462-1178"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NORTHERN CALIFORNIA MEDICAL ASSOC INC",
"organizational_subpart": "NO",
"enumeration_date": "2010-11-19",
"last_updated": "2012-02-09",
"status": "A",
"authorized_official_last_name": "SKIDMORE",
"authorized_official_first_name": "RUTH",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
"authorized_official_telephone_number": "707-573-6925",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207RC0200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Critical Care Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Pulmonary Disease",
"state": null,
"license": null,
"primary": true
},
{
"code": "207RS0012X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Sleep Medicine",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1598067720",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "ZZZ03529Z",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Ukiah, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.