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PROVIDENCE MEDICAL FOUNDATION
NPI 1265015978
Family Medicine in Santa Rosa, CA

Active since April 30, 2021CLIA Certified · 5 labs
185 SOTOYOME ST, SANTA ROSA, CA 95405(707) 303-8355(707) 303-2035 Get Directions Write a Review

NPPES record last updated: January 6, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 6, 2026, Jul 12, 2022, Apr 30, 2021 (3 updates tracked since 2021).

About Providence Medical Foundation NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE MEDICAL FOUNDATION (NPI 1265015978) is a healthcare organization registered as a family medicine in Santa Rosa, California and active in the NPI registry since April 2021. The organization holds 5 active CLIA laboratory certificates and lists Donald W. Anderson, Assistant Secretary Of Enrollments, as its authorized official.

NPPES Registry Identity

NPI1265015978
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NamePROVIDENCE MEDICAL FOUNDATION
Location Address185 SOTOYOME STSanta Rosa, CA 95405-4803
Mailing AddressPo Box 31001 - 1920Pasadena, CA 91110-1920 · (707) 303-8355 · Fax (707) 303-2035
Phone(707) 303-8355
Fax(707) 303-2035
Organization SubpartNo
Authorized OfficialDonald W. AndersonAssistant Secretary Of Enrollments · (425) 358-9786
Enumeration DateApril 30, 2021
Last NPPES UpdateJanuary 6, 20263 updates tracked since enumeration
NPPES CertifiedJanuary 6, 2026
✔ NPI 1265015978 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
185 SOTOYOME ST, Santa Rosa, CA 95405
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Other Names 1

Other NameProvidence Medical Group Northern California

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 5

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 05D2080771

Providence Medical Foundation · Santa Rosa, CA
Active · expires Jul 13, 2028
CLIA Number05D2080771
Laboratory TypePhysician Office
Certificate Effective DateJuly 14, 2026
Certificate Expiration DateJuly 13, 2028
Laboratory DirectorPaul Mc Adams
Laboratory Phone(707) 303-8323
Laboratory LocationProvidence Medical Foundation510 Doyle Park Dr, Santa Rosa, CA 95405
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate of Waiver 05D0676808

Providence Medical Foundation · Santa Rosa, CA
Active · expires Jan 30, 2028
CLIA Number05D0676808
Laboratory TypePhysician Office
Certificate Effective DateJanuary 31, 2026
Certificate Expiration DateJanuary 30, 2028
Laboratory DirectorDr. Elizabeth Culhane
Laboratory Phone(707) 544-6090
Laboratory LocationProvidence Medical Foundation500 Doyle Park Dr, Ste 100, Santa Rosa, CA 95405
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2221461

Providence Medical Foundation Doyle Park Family Practice · Santa Rosa, CA
Active · expires Jul 17, 2027
CLIA Number05D2221461
Laboratory TypePhysician Office
Certificate Effective DateJuly 18, 2025
Certificate Expiration DateJuly 17, 2027
Laboratory DirectorJames Trapnell
Laboratory Phone(707) 303-8312
Laboratory LocationProvidence Medical Foundation Doyle Park Family Practice500 Doyle Park Dr, Ste 303, Santa Rosa, CA 95405
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 05D2320124

Providence Medical Group · Santa Rosa, CA
Active · expires Mar 11, 2027
CLIA Number05D2320124
Laboratory TypePhysician Office
Certificate Effective DateMarch 12, 2025
Certificate Expiration DateMarch 11, 2027
Laboratory DirectorYuichiro D. Nakai
Laboratory Phone(707) 890-4250
Laboratory LocationProvidence Medical Group1162 Montgomery Drive 3rd Floor, Santa Rosa, CA 95405
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 05D2084021

Providence Medical Foundation · Santa Rosa, CA
Active · expires Oct 4, 2026
CLIA Number05D2084021
Laboratory TypePhysician Office
Certificate Effective DateOctober 5, 2024
Certificate Expiration DateOctober 4, 2026
Laboratory DirectorGregory Sacher, MD
Laboratory Phone(707) 303-1719
Laboratory LocationProvidence Medical Foundation500 Doyle Park Dr Ste 200, Santa Rosa, CA 95405
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Medical Foundation's NPI number?

The NPI number for Providence Medical Foundation is 1265015978. It was assigned to this organization in the NPPES registry on April 30, 2021. The provider is also known as Providence Medical Group Northern California.

Where is Providence Medical Foundation located?

Providence Medical Foundation is located at 185 Sotoyome St, Santa Rosa, CA 95405. The listed phone number is (707) 303-8355.

What is Providence Medical Foundation's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Providence Medical Foundation hold CLIA laboratory certificates?

Yes. 5 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Providence Medical Foundation was last updated on January 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.