Individual provider Active NPI

Courtney Keith White, M.D.

  • Surgical Critical Care Physician
  • French Camp, CA
National Provider Identifier
1831501089
Registry record updated Aug 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
145761 Issued in CA
Practice address
500 W Hospital Rd
French Camp, CA 95231-9693
Phone
(209) 468-6937
Fax
(209) 468-7042
NPI assigned
May 22, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 31, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care Physician 2086S0102X 145761 CA Primary

Addresses

Primary practice location

500 W Hospital Rd
French Camp, CA 95231-9693

Mailing address

2335 Stockton Blvd
5TH Floor
Sacramento, CA 95817

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
I20200629000143 CA Practitioner - General Surgery 8224450887 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

121 Sotoyome St
Santa Rosa, CA 95405-4823
Phone (707) 525-6623

Hospital & facility affiliations

  • Providence Santa Rosa Memorial Hospital Hospital, Santa Rosa, CA, CCN 050174
  • Healdsburg Hospital Hospital, Healdsburg, CA, CCN 051321
  • Adventist Health Clearlake Hospital, Clearlake, CA, CCN 051317

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
145761CAMDSurgical Critical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Jun 23, 2020 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Jun 23, 2020 Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

121 Sotoyome St
Santa Rosa, CA 95405
Phone (707) 546-3141

1165 Montgomery Dr
Santa Rosa, CA 95405
Phone (707) 525-5300

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

Interoperability endpoints

  • Direct secure messaging: cwhite1658457@oc.providencedirect.org
  • Direct secure messaging: cwhite365857@hisp.ehr.sutterhealth.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1400716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1831501089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2335 STOCKTON BLVD",
            "address_2": "5TH FLOOR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W HOSPITAL RD",
            "city": "FRENCH CAMP",
            "state": "CA",
            "postal_code": "952319693",
            "telephone_number": "209-468-6937",
            "fax_number": "209-468-7042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "COURTNEY",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-05-22",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "CA",
            "license": "145761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in French Camp, CA

Sources for this page

Verify at the official NPI Registry.