NPIMap

Individual provider Active NPI

Jason Cunningham, DO

  • Family Medicine Physician
  • Sebastopol, CA
National Provider Identifier
1811990237
Registry record updated Jun 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A8284 Issued in CA
Practice address
6800 Palm Ave
Suite C
Sebastopol, CA 95472-4269
Phone
(707) 824-9999
Fax
(707) 824-2853
NPI assigned
May 31, 2005
Last updated
Jun 25, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A8284 CA Primary

Addresses

Primary practice location

6800 Palm Ave
Suite C
Sebastopol, CA 95472-4269

Mailing address

PO Box 1449
Guerneville, CA 95446-1449
Phone (707) 869-5977

Other identifiers 5

IdentifierTypeStateIssuer
00AX82840MedicaidCA
1598768962MedicaidCA
ZZZ23666ZOtherCABLUE SHIELD PIN
1356344758MedicaidCA
1538334065MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130524000430 CA Order and Referring Only - Family PracticePractitioner - Family Practice 3779479142

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West County Health Centers, Inc.Group PAC ID 6800782277, shared by 6 NPIs, 20 clinicians

Practice addresses (Care Compare)

PO Box
Suite 1449
Guerneville, CA 95446

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8284CAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph Health Northern California, LLC Past Accepting new patients
West County Health Centers, Inc. Past Accepting new patients
Chase Dennis Emergency Medical Group Inc Family Medicine Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jason.cunningham@wchealth.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
West County Health Centers, Inc.Guerneville, CA, CCN 051100 Federally qualified health center Corporate Director Mar 5, 2020
Sebastopol Community Health CenterSebastopol, CA, CCN 051140 Federally qualified health center Corporate Director Mar 5, 2020
Russian River Health CenterGuerneville, CA, CCN 551839 Federally qualified health center Corporate Officer Mar 5, 2020
West County Health Centers, Inc.Occidental, CA, CCN 551803 Federally qualified health center Corporate Director Mar 5, 2020
Gravenstein Community Health CenterSebastopol, CA, CCN 751113 Federally qualified health center Corporate Officer Mar 5, 2020
Gravenstein South Health CenterSebastopol, CA, CCN A01129 Federally qualified health center Corporate Officer Mar 5, 2020

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435190400000",
    "number": "1811990237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1449",
            "city": "GUERNEVILLE",
            "state": "CA",
            "postal_code": "954461449",
            "telephone_number": "707-869-5977",
            "fax_number": "707-869-5983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 PALM AVE",
            "address_2": "SUITE C",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724269",
            "telephone_number": "707-824-9999",
            "fax_number": "707-824-2853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUNNINGHAM",
        "first_name": "JASON",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-31",
        "last_updated": "2015-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A8284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX82840",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1598768962",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PIN",
            "identifier": "ZZZ23666Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356344758",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538334065",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sebastopol, CA

Sources for this page

Verify at the official NPI Registry.