Individual provider Active NPI

Gary Mishkin, M.D.

  • Family Medicine Physician
  • Saint Helena, CA
National Provider Identifier
1912981382
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G56321 Issued in CA
Practice address
10 Woodland Rd
Saint Helena, CA 94574-9554
Phone
(707) 963-3611
NPI assigned
Nov 30, 2005
Last updated
Mar 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X CAG056321 CA
Family Medicine Physician 207Q00000X G56321 CA Primary

Addresses

Primary practice location

10 Woodland Rd
Saint Helena, CA 94574-9554

Mailing address

10 Woodland Rd
Saint Helena, CA 94574-9554
Phone (707) 963-3611

Other identifiers 1

IdentifierTypeStateIssuer
CAG056321OtherCASTATE LICENSE NUMBER

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
I20041213000365 CA Practitioner - Family PracticePractitioner - Emergency Medicine 7810954708 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CAG056321CAMDEmergency Medicine Physician
G56321CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chase Dennis Emergency Medical Group Inc Emergency Medicine CurrentSince Nov 1, 2004 Accepting new patients
Providence Medical Foundation CurrentSince Apr 1, 2016 Accepting new patients
Norcal Healthconnect LLC CurrentSince Feb 22, 2024 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation Family Medicine CurrentSince Apr 1, 2016 Accepting new patients
Norcal Healthconnect LLC Current Accepting new patients
Norcal Healthconnect LLC CurrentSince Feb 22, 2024 Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Queen of the Valley Medical Association Past Accepting new patients

Locations

1375 University St
Healdsburg, CA 95448
Phone (707) 385-2025

110 Lynch Creek Way
#B
Petaluma, CA 94954
Phone (707) 522-4348

1450 Medical Center Dr
Rohnert Park, CA 94928
Phone (707) 546-3210

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

501 Petaluma Ave
Sebastopol, CA 95472
Phone (707) 823-8511

Interoperability endpoints

  • Direct secure messaging: gmishkin@yourcarecommunity.org

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1912981382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 WOODLAND RD",
            "city": "SAINT HELENA",
            "state": "CA",
            "postal_code": "945749554",
            "telephone_number": "707-963-3611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 WOODLAND RD",
            "city": "SAINT HELENA",
            "state": "CA",
            "postal_code": "945749554",
            "telephone_number": "707-963-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISHKIN",
        "first_name": "GARY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "CAG056321",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G56321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "CAG056321",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Helena, CA

Sources for this page

Verify at the official NPI Registry.