NPIMap

Individual provider Active NPI

Carla Price Longchamp, M.D.

  • Family Medicine Physician
  • Santa Rosa, CA
National Provider Identifier
1972544948
Registry record updated Jul 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G76332 Issued in CA
Practice address
1300 N Dutton Ave
Santa Rosa, CA 95401-7112
Phone
(707) 459-6861
NPI assigned
Jun 9, 2006
Last updated
Jul 23, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G76332 CA Primary

Addresses

Primary practice location

1300 N Dutton Ave
Santa Rosa, CA 95401-7112

Mailing address

1245 S Main St
Willits, CA 95490-4305
Phone (707) 459-6861

Other practice location 1

1245 S Main St
Willits, CA 95490-4305
Phone (707) 459-6861

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
I20051006000906 CA Practitioner - Family Practice 8729003942 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of California, San Francisco School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1300 N Dutton Ave
Santa Rosa, CA 95401-7112
Phone (707) 303-3600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
76332CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Long Valley Health Center CurrentSince Nov 10, 2012 Accepting new patients
Santa Rosa Community Health Centers CurrentSince Feb 17, 2024 Accepting new patients
Santa Rosa Community Health Centers CurrentSince Feb 17, 2024 Accepting new patients
John R Glyer D Mills Matheson & Margaret Arner MDS PTR CurrentSince Sep 1, 1999 Accepting new patients
Santa Rosa Community Health Centers Current Accepting new patients

Locations

50 Branscomb Rd
Laytonville, CA 95454
Phone (707) 984-6131

1300 N Dutton Ave
Santa Rosa, CA 95401
Phone (707) 303-3395

3569 Round Barn Cir
Santa Rosa, CA 95403

1245 S Main St
Willits, CA 95490
Phone (707) 459-6861

Interoperability endpoints

  • Direct secure messaging: clongchamp627422@direct.ochin.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/AECBBA

Organizations & group practices 5

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": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532304000000",
    "number": "1972544948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 S MAIN ST",
            "city": "WILLITS",
            "state": "CA",
            "postal_code": "954904305",
            "telephone_number": "707-459-6861",
            "fax_number": "707-459-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N DUTTON AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954017112",
            "telephone_number": "707-459-6861"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1245 S Main St",
            "address_purpose": "LOCATION",
            "city": "Willits",
            "state": "CA",
            "postal_code": "954904305",
            "country_code": "US",
            "telephone_number": "707-459-6861",
            "fax_number": "707-459-3057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LONGCHAMP",
        "first_name": "CARLA",
        "middle_name": "PRICE",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-09",
        "last_updated": "2018-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G76332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.