NPIMap

Individual provider Active NPI

Dugald Chisholm III, M.D.

  • Emergency Medicine Physician
  • Templeton, CA
National Provider Identifier
1912103284
Registry record updated Dec 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A110029 Issued in CA
Practice address
105 S Main St
Ste 4
Templeton, CA 93465-9601
Phone
(805) 434-1869
NPI assigned
Jun 25, 2007
Last updated
Dec 3, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A110029 CA Primary

Addresses

Primary practice location

105 S Main St
Ste 4
Templeton, CA 93465-9601

Mailing address

105 S Main St
Ste 4
Templeton, CA 93465-9601
Phone (805) 434-1869

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dchisholm1986595@oc.providencedirect.org

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
I20100818000513 CA Practitioner - Emergency Medicine 9931251113 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Tufts University School of Medicine, 2007
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)

2700 Dolbeer St
Eureka, CA 95501-4736
Phone (707) 445-8121

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A110029CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Sep 7, 2021 Accepting new patients
Providence Medical Foundation CurrentSince Sep 7, 2021 Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Queen of the Valley Medical Association Past Accepting new patients

Locations

2700 Dolbeer St
Eureka, CA 95501
Phone (707) 269-4229

3300 Renner Dr
Fortuna, CA 95540
Phone (707) 725-3361

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: dchisholm1986595@oc.providencedirect.org

Organizations & group practices 8

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 3

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": "1182729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1912103284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 S MAIN ST",
            "address_2": "STE 4",
            "city": "TEMPLETON",
            "state": "CA",
            "postal_code": "934659601",
            "telephone_number": "805-434-1869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S MAIN ST",
            "address_2": "STE 4",
            "city": "TEMPLETON",
            "state": "CA",
            "postal_code": "934659601",
            "telephone_number": "805-434-1869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHISHOLM",
        "first_name": "DUGALD",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-25",
        "last_updated": "2021-12-03",
        "certification_date": "2021-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A110029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dchisholm1986595@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "2700 Dolbeer St",
            "city": "Eureka",
            "state": "CA",
            "country_code": "US",
            "postal_code": "955014736",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Templeton, CA

Sources for this page

Verify at the official NPI Registry.