NPIMap

Individual provider Active NPI

Frederick Charles David, M.D.

  • Radiation Oncology Physician
  • Santa Rosa, CA
National Provider Identifier
1982793808
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
G34598 Issued in CA
Practice address
3555 Round Barn Circle
Santa Rosa, CA 95403-1757
Phone
(707) 528-1050
Fax
(707) 576-0445
NPI assigned
Oct 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X G34598 CA Primary
Therapeutic Radiology Physician 2085R0203X G34598 CA

Addresses

Primary practice location

3555 Round Barn Circle
Santa Rosa, CA 95403-1757

Mailing address

3555 Round Barn Circle
Santa Rosa, CA 95403-1757
Phone (707) 528-1050

Other identifiers 1

IdentifierTypeStateIssuer
00G345980MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address fdavid1657608@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
I20080924000652 CA Practitioner - Radiation Oncology 7618044165 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
University of California, Geffen School of Medicine, 1976
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

Practice addresses (Care Compare)

1165 Montgomery Dr
Santa Rosa, CA 95405-4801
Phone (707) 546-3210

200 W Ctr St Promenade
Anaheim, CA 92805-3960

3555 Round Barn Cir
Santa Rosa, CA 95403-1757
Phone (707) 528-1050

500 Doyle Park Dr
Santa Rosa, CA 95405-4559

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34598CAMDNutrition Chiropractor
G34598CAMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Feb 25, 2014 Accepting new patients
Providence Medical Foundation CurrentSince Feb 25, 2014 Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Annadel Medical Group, Inc Past Accepting new patients
Redwood Regional Medical Group Inc Radiation Oncology Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

1100 Trancas St
Ste 256
Napa, CA 94558
Phone (707) 253-7161

110 Lynch Creek Way
#A
Petaluma, CA 94954
Phone (707) 763-0600

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

3555 Round Barn Cir
Santa Rosa, CA 95403
Phone (707) 528-1050

3555 Round Barn Cir
#100
Santa Rosa, CA 95403

121 Sotoyome St
Ste 101
Santa Rosa, CA 95405
Phone (707) 525-1150

121 Sotoyome St
Santa Rosa, CA 95405
Phone (707) 546-3141

652 Petaluma Ave
Ste B
Sebastopol, CA 95472
Phone (707) 823-8565

1165 S Dora St
Bldg H
Ukiah, CA 95482
Phone (707) 463-3636

Interoperability endpoints

  • Direct secure messaging: frederick.david@stjoe.direct.varian.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1982793808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 ROUND BARN CIRCLE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031757",
            "telephone_number": "707-528-1050",
            "fax_number": "707-576-0445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 ROUND BARN CIRCLE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031757",
            "telephone_number": "707-528-1050",
            "fax_number": "707-576-0445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVID",
        "first_name": "FREDERICK",
        "middle_name": "CHARLES",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "CA",
            "license": "G34598",
            "primary": true
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "CA",
            "license": "G34598",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G345980",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "fdavid1657608@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "110 Lynch Creek Way # A",
            "city": "Petaluma",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949542337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.