Jerry A Davidson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G33458 Issued in CA

Practice address

2876 Sycamore Dr
Suite 101
Simi Valley, CA 93065-1550

Phone

(805) 527-6424

Fax

(805) 522-0115

NPI assigned

Feb 22, 2006

Last updated

Apr 19, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303171200000",
    "number": "1922073998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2876 SYCAMORE DR",
            "address_2": "SUITE 101",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651550",
            "telephone_number": "805-527-6424",
            "fax_number": "805-522-0115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2876 SYCAMORE DR",
            "address_2": "SUITE 101",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651550",
            "telephone_number": "805-527-6424",
            "fax_number": "805-522-0115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "JERRY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2011-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G33458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G334580",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nathalie R Darmawan
• Lucia Loredana Dattoma, MD
• Dave Hallbauer (VCBH-SimiValley Children's Mental Health)
• David B. Rosenfeld, M.D., Inc.
• David M. Gudeman, M.D., Inc.
• Dantae D. Davies, M.D.
• Austin Parker Davis
• Caitlin Alyse Davis, AUD
• Daniel K. Davis, MD
• Daysa Davis

• Family Medicine Physician in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.