Nathan S Anderson, M.D.
Individual provider Active NPI Cardiovascular Disease Physician · Travis Afb, CA
NPI 1861698656 · NPPES record last updated Apr 15, 2020
Key facts
- NPI
- 1861698656
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- MED-PHYS-LIC-81009 (MT)
- Practice address
- 101 Bodin Cir
60MDG/SGCS Heart, Lung and Vascular Institute
Travis Afb, CA 94535-1809 - Phone
- (707) 423-5136
- NPI assigned
- Jun 27, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Providence Medical Foundation
Practice addresses (Care Compare)
500 Doyle Park Dr
Suite 103
Santa Rosa, CA 95405-4559
Phone (707) 303-8330
Hospital & facility affiliations
- Providence Santa Rosa Memorial Hospital
- Healdsburg Hospital
- Petaluma Valley Hospital
- Adventist Health Mendocino Coast
- Providence St Joseph Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230727002890 | CA | Practitioner - Cardiovascular Disease (Cardiology) | 9537599253 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101245111 | VA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Medical Foundation | Current | Accepting new patients | |
| Providence Medical Foundation | Current |
Accepting new patients | |
| Providence Medical Foundation | Current |
Accepting new patients | |
| Providence Health & Services Mt | Past | Accepting new patients | |
| Providence Medical Foundation | Past | Accepting new patients | |
| St. Joseph Health Northern California, LLC | Past | Accepting new patients | |
| St Joseph Hospital of Orange | Past | Accepting new patients |
Locations
200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841
500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842
500 Doyle Park Dr
Ste 103
Santa Rosa, CA 95405
Phone (707) 303-8330
1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 0101245111 | VA | |
| Cardiovascular Disease Physician | 207RC0000X | MED-PHYS-LIC-81009 | MT | Yes |
| Internal Medicine Physician | 207R00000X | 0101245111 | VA |
Addresses
Primary practice location
101 Bodin Cir
60MDG/SGCS Heart, Lung and Vascular Institute
Travis Afb, CA 94535-1809
Mailing address
PO Box 12
Liberty Lake, WA 99019-0012
Phone (866) 747-2455
Other providers in Travis Afb, CA
- Andrew James Amack
- Emilee Dailey Amacker
- Michael Leonardo Amashta
- Max American
- David Michael Fredric Anderson
- Allan Anthony Andres
- Jennifer Lynn Andrews-Burke
- Joscelyn D. a. C. Aquiningoc
- Patrick Arevalo
- Maryanne Armada
All providers in Travis Afb, CA · Cardiovascular Disease Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.