Individual provider Active NPI

Corrine Lee Douglas, NP

  • Critical Care Pediatric Nurse Practitioner
  • Santa Cruz, CA
National Provider Identifier
1720481526
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Pediatric Nurse PractitionerTaxonomy code 363LP0222X
License
NP95001430 Issued in CA
Practice address
1510 Capitola Rd
Santa Cruz, CA 95062-2912
Phone
(831) 427-3500
NPI assigned
Oct 7, 2014
Last updated
May 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Pediatric Nurse Practitioner 363LP0222X NP95001430 CA Primary

Addresses

Primary practice location

1510 Capitola Rd
Santa Cruz, CA 95062-2912

Mailing address

PO Box 542
Santa Cruz, CA 95061-0542
Phone (831) 427-3500

Other practice location 1

231 Main St Ste A
Ben Lomond, CA 95005-9394
Phone (831) 427-3500

Other practice location 2

250 Locust St
Santa Cruz, CA 95060-3813
Phone (831) 427-3500

Other practice location 3

751 S Bascom Ave
San Jose, CA 95128-2604
Phone (408) 857-3150

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160906001638 CA Practitioner - Nurse Practitioner 5890081566 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP95001430CAMDCritical Care Pediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
County of Santa Clara CurrentSince Jun 5, 2025 Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara Current Accepting new patients
Santa Cruz Community Health Centers Past Accepting new patients

Locations

7475 Camino Arroyo
Gilroy, CA 95020
Phone (408) 852-2400

1993 McKee Rd
San Jose, CA 95116
Phone (408) 254-6320

1996 Lundy Ave
San Jose, CA 95131
Phone (408) 299-5846

2101 Alexian Dr
San Jose, CA 95116
Phone (408) 272-6050

500 Tully Rd
San Jose, CA 95111
Phone (408) 817-1433

750 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-2320

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

660 S Fair Oaks Ave
Sunnyvale, CA 94086
Phone (408) 885-7366

Interoperability endpoints

  • Direct secure messaging: cdenworth51828@santaclaravalley.direct-ci.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1720481526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 542",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950610542",
            "telephone_number": "831-427-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 CAPITOLA RD",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950622912",
            "telephone_number": "831-427-3500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "231 Main St Ste A",
            "address_purpose": "LOCATION",
            "city": "Ben Lomond",
            "state": "CA",
            "postal_code": "950059394",
            "country_code": "US",
            "telephone_number": "831-427-3500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "250 Locust St",
            "address_purpose": "LOCATION",
            "city": "Santa Cruz",
            "state": "CA",
            "postal_code": "950603813",
            "country_code": "US",
            "telephone_number": "831-427-3500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "751 S Bascom Ave",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951282604",
            "country_code": "US",
            "telephone_number": "408-857-3150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "CORRINE",
        "middle_name": "LEE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-07",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0222X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics, Critical Care",
            "state": "CA",
            "license": "NP95001430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

Verify at the official NPI Registry.