Individual provider Active NPI

William Peter Carlson, MD

  • Family Medicine Physician
  • McKinleyville, CA
National Provider Identifier
1760426761
Registry record updated Mar 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G32605 Issued in CA
Practice address
1644 Central Ave
McKinleyville, CA 95519-4342
Phone
(707) 839-3068
Fax
(707) 839-3827
NPI assigned
Jun 16, 2006
Last updated
Mar 1, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X G32605 CA
Family Medicine Physician 207Q00000X G32605 CA Primary

Addresses

Primary practice location

1644 Central Ave
McKinleyville, CA 95519-4342

Mailing address

670 9TH St
Suite 203
Arcata, CA 95521-6248
Phone (707) 826-8633

Other identifiers 1

IdentifierTypeStateIssuer
00G326050MedicaidCA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031118001180 CA Practitioner - Family PracticePractitioner - Emergency Medicine 8123932589 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
32605CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Open Door Community Health Centers Current Accepting new patients
Open Door Community Health Centers Current Accepting new patients
Open Door Community Health Centers Current Accepting new patients
Open Door Community Health Centers Current Accepting new patients
Open Door Community Health Centers CurrentSince Sep 14, 2009 Accepting new patients
Open Door Community Health Centers CurrentSince Sep 14, 2009 Accepting new patients
Open Door Community Health Centers PastSince Jun 2, 2024 Accepting new patients
Six Rivers Emergency Physicians Emergency Medicine Past Accepting new patients

Locations

1275 8th St
Arcata, CA 95521

770 10th St
Arcata, CA 95521
Phone (707) 826-8610

785 18th St
Arcata, CA 95521
Phone (707) 822-2481

550 E Washington Blvd
Crescent City, CA 95531
Phone (707) 465-6925

550 E Washington Blvd
Ste 100
Crescent City, CA 95531
Phone (707) 465-6925

2200 Tydd St
Eureka, CA 95501
Phone (707) 441-1624

3750 Rohnerville Rd
Fortuna, CA 95540
Phone (707) 725-4477

1644 Central Ave
McKinleyville, CA 95519
Phone (707) 839-3068

670 9th St
Ste 203
McKinleyville, CA 95521

Organizations & group practices 8

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330560000000",
    "number": "1760426761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 9TH ST",
            "address_2": "SUITE 203",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955216248",
            "telephone_number": "707-826-8633",
            "fax_number": "707-826-8638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1644 CENTRAL AVE",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955194342",
            "telephone_number": "707-839-3068",
            "fax_number": "707-839-3827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "WILLIAM",
        "middle_name": "PETER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2012-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G32605",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G32605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G326050",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McKinleyville, CA

Sources for this page

Verify at the official NPI Registry.