Individual provider Active NPI

Anders Davidson, MD

  • Vascular Surgery Physician
  • Travis AFB, CA
National Provider Identifier
1881957694
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
A128374 Issued in CA
Practice address
101 Bodin Cir
Travis AFB, CA 94535-1809
Phone
(707) 423-3000
NPI assigned
Jun 18, 2012
Last updated
Mar 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X A128374 CA Primary

Addresses

Primary practice location

101 Bodin Cir
Travis AFB, CA 94535-1809

Mailing address

101 Bodin Cir
Travis AFB, CA 94535-1809

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
I20220114002049 CA Practitioner - Vascular SurgeryPractitioner - General Surgery 9830493535 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians
Regents of the Univ of CaGroup PAC ID 3375456619, 1,571 clinicians

Practice addresses (Care Compare)

1162 Montgomery Dr
Suite 300
Santa Rosa, CA 95405-4802
Phone (707) 890-4250

2221 Stockton Blvd
Sacramento, CA 95817-1418
Phone (916) 734-3761

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)14
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A128374CAMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the Univ of Ca Current Accepting new patients
Providence Medical Foundation CurrentSince Aug 7, 2023 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Regents of the Univ of Ca CurrentSince Dec 16, 2021 Accepting new patients
Pinnacle Sjir CurrentSince Aug 27, 2023 Accepting new patients
Regents of the Univ of Ca CurrentSince Dec 16, 2021 Accepting new patients
Providence Medical Foundation CurrentSince Aug 7, 2023 Accepting new patients
Northbay Health Medical Foundation CurrentSince Jan 1, 2026 Accepting new patients
Northbay Healthcare Group CurrentSince Feb 15, 2023 Accepting new patients
Northbay Healthcare Group CurrentSince Feb 15, 2023 Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Adventist Health Heart Institute-Ukiah Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Dameron Hospital Association Past Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

1200 B Gale Wilson Blvd
Fairfield, CA 94533
Phone (707) 429-3600

1860 Pennsylvania Ave
Ste 110
Fairfield, CA 94533
Phone (707) 254-9693

145 Trevino Ave
Manteca, CA 95337
Phone (209) 788-8180

3250 Beard Rd
Napa, CA 94558
Phone (707) 224-7944

2221 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-2680

2315 Stockton Blvd
#512
Sacramento, CA 95817
Phone (916) 734-2724

4860 Y St
Sacramento, CA 95817
Phone (916) 734-2700

4868 X St
Sacramento, CA 95817
Phone (916) 703-1503

4900 Broadway
Ste 2800
Sacramento, CA 95820
Phone (916) 734-9313

1162 Montgomery Dr
Ste 300
Santa Rosa, CA 95405
Phone (707) 547-5437

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

525 W Acacia St
Stockton, CA 95203
Phone (209) 944-5410

1000 Nut Tree Rd
Vacaville, CA 95687
Phone (707) 446-4000

1010 Nut Tree Rd
Ste 100B
Vacaville, CA 95687
Phone (707) 646-7999

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: adavidson190346@hisp.ehr.sutterhealth.org
  • Direct secure messaging: adavidson2959778@oc.providencedirect.org
  • Direct secure messaging: anders.davidson.1@8236.direct.athenahealth.com
  • Direct secure messaging: anders.davidson.2@8236.direct.athenahealth.com

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 2

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": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1881957694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "ANDERS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-18",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "A128374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Travis AFB, CA

Sources for this page

Verify at the official NPI Registry.