NPIMap

Individual provider Active NPI

Gary D Wikholm, MD

  • Family Medicine Physician
  • Santa Paula, CA
National Provider Identifier
1861598526
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A41000 Issued in CA
Practice address
247 W Harvard Blvd
Santa Paula, CA 93060-3223
Phone
(805) 525-0907
Fax
(805) 933-3392
NPI assigned
Sep 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 A41000 CA Primary

Addresses

Primary practice location

247 W Harvard Blvd
Santa Paula, CA 93060-3223

Mailing address

247 W Harvard Blvd
Santa Paula, CA 93060-3223
Phone (805) 525-0907

Other identifiers 1

IdentifierTypeStateIssuer
00A410000MedicaidCA

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
I20080108000884 CA Practitioner - Family Practice 9234231176 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

247 W Harvard Blvd
Santa Paula, CA 93060-3223
Phone (805) 525-0907

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A41000CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Ventura CurrentSince Dec 24, 2016 Accepting new patients
County of Ventura CurrentSince Dec 24, 2016 Accepting new patients
Community Memorial Health System Past Accepting new patients

Locations

825 N 10th St
Santa Paula, CA 93060
Phone (805) 933-8600

247 W Harvard Blvd
Santa Paula, CA 93060
Phone (805) 525-0907

3291 Loma Vista Rd
Ventura, CA 93003
Phone (805) 652-6000

800 S Victoria Ave
#L4640
Ventura, CA 93009

133 W Santa Clara St
Ventura, CA 93001
Phone (805) 641-5600

300 Hillmont Ave
Ventura, CA 93003
Phone (805) 652-6000

Interoperability endpoints

  • Direct secure messaging: gary.wikholm.p1@direct.gwikholm.nextgenshare.com

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 and National Provider Directory roles.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861598526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 W HARVARD BLVD",
            "city": "SANTA PAULA",
            "state": "CA",
            "postal_code": "930603223",
            "telephone_number": "805-525-0907",
            "fax_number": "805-933-3392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 W HARVARD BLVD",
            "city": "SANTA PAULA",
            "state": "CA",
            "postal_code": "930603223",
            "telephone_number": "805-525-0907",
            "fax_number": "805-933-3392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIKHOLM",
        "first_name": "GARY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A41000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A410000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Paula, CA

Sources for this page

Verify at the official NPI Registry.