Active NPI
Gwen Jill Summerville, M.D.
- Psychiatry Physician
- San Francisco, CA
National Provider Identifier
1700068376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A63260
- Practice address
- 5815 3Rd St
San Francisco, CA 94124-3101 - Phone
- (415) 822-7500
- NPI assigned
- Dec 5, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A63260 | CA | Primary |
Addresses
Primary practice location
5815 3Rd St
San Francisco, CA 94124-3101
Mailing address
5815 3Rd St
San Francisco, CA 94124-3101
Phone (415) 822-7500
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 |
|---|---|---|---|
| A63260 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420588800000",
"number": "1700068376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5815 3RD ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941243101",
"telephone_number": "415-822-7500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5815 3RD ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941243101",
"telephone_number": "415-822-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUMMERVILLE",
"first_name": "GWEN",
"middle_name": "JILL",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-12-05",
"last_updated": "2015-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A63260",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.