Active NPI
David J Quenelle, M.D.
- Otolaryngology Physician
- Santa Rosa, CA
National Provider Identifier
1710909791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- G13985
- Practice address
- 1701 4TH St
Ste 120
Santa Rosa, CA 95404-3661 - Phone
- (707) 523-7025
- Fax
- (707) 523-3024
- NPI assigned
- Jul 25, 2006
- Last updated
- Feb 7, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | G13985 | CA | Primary |
Addresses
Primary practice location
1701 4TH St
Ste 120
Santa Rosa, CA 95404-3661
Mailing address
3536 Mendocino Ave
Ste 200
Santa Rosa, CA 95403-3634
Phone (707) 575-6049
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00933214 | Other | CA | RAILROAD MEDICARE |
| 00G139850 | Medicaid | CA |
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 |
|---|---|---|---|
| G13985 | CA | MD | Otolaryngology Physician |
| 13985 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Santa Rosa Head and Neck Surgical Group, Inc | Otolaryngology | Past | Accepting new patients |
| Santa Rosa Trauma Physicians Medical Group | Otolaryngology | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Otolaryngology Physician
- Santa Rosa, CA
- NPI 1114969441
-
- Trauma Surgery Physician
- Santa Rosa, CA
- NPI 1184673162
Otolaryngology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328572800000",
"number": "1710909791",
"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": "707-523-3024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 4TH ST",
"address_2": "STE 120",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954043661",
"telephone_number": "707-523-7025",
"fax_number": "707-523-3024"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUENELLE",
"first_name": "DAVID",
"middle_name": "J",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2012-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "CA",
"license": "G13985",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00933214",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G139850",
"state": "CA"
}
],
"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 Feb 7, 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.