NPIMap

Organization Active NPI

Northern California Medical Assoc Inc

  • Gastroenterology Physician
  • Santa Rosa, CA
National Provider Identifier
1689226649
Registry record updated Jul 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
NORTHERN CALIFORNIA MEDICAL ASSOC INC
Practice address
1701 4TH St Ste 100
Santa Rosa, CA 95404-3661
Phone
(707) 569-3234
NPI assigned
Jul 10, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2019

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

Authorized official

Name
Sally A Dewald
Title
Business Services Manager
Phone
(707) 525-6485

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X Primary
Hepatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0008X

Addresses

Primary practice location

1701 4TH St Ste 100
Santa Rosa, CA 95404-3661

Mailing address

3536 Mendocino Ave Ste 200
Santa Rosa, CA 95403-3634
Phone (707) 545-6485

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1562716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562716800000",
    "number": "1689226649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3536 MENDOCINO AVE STE 200",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033634",
            "telephone_number": "707-545-6485",
            "fax_number": "707-573-6918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 4TH ST STE 100",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954043661",
            "telephone_number": "707-569-3234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN CALIFORNIA MEDICAL ASSOC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-10",
        "last_updated": "2019-07-10",
        "status": "A",
        "authorized_official_last_name": "DEWALD",
        "authorized_official_first_name": "SALLY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "BUSINESS SERVICES MANAGER",
        "authorized_official_telephone_number": "707-525-6485"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0008X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hepatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 Jul 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.