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

NPI Status: Active since April 30, 2021

Contact Information

185 SOTOYOME ST
SANTA ROSA, CA
ZIP 95405
Phone: (707) 303-8355
Fax: (707) 303-2035

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  • Organization
  • Family Medicine
  • CLIA Number: 05D0676808
  • CLIA Cert. Type: Physician Office
  • CLIA Exp. Date: 01-30-2028

About PROVIDENCE MEDICAL FOUNDATION

This page provides the complete NPI Profile along with additional information for Providence Medical Foundation, a primary care provider established in Santa Rosa, California operating as a Family Medicine. The healthcare provider is registered in the NPI registry with number 1265015978 assigned on April 2021. The practitioner's primary taxonomy code is 207Q00000X. The provider is registered as an organization and their NPI record was last updated January 2026. Providence Medical Foundation operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The provider's . The authorized official of this NPI record is Donald W. Anderson Jr. (Assistant Secretary Of Enrollments)

NPI
1265015978
Provider Legal Name
PROVIDENCE MEDICAL FOUNDATION
Other Organization Name
Other Name Type
(6)
Entity Type
Organization
Location Address
185 SOTOYOME ST SANTA ROSA, CA 95405
Location Phone
(707) 303-8355
Location Fax
(707) 303-2035
Mailing Address
PO BOX 31001 - 1920 PASADENA, CA 91110
Mailing Phone
(707) 303-8355
Mailing Fax
(707) 303-2035
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
04-30-2021
Last Update Date
01-06-2026
Code Navigator

A primary care provider (PCP) like Providence Medical Foundation sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Family Medicine

Taxonomy Code
207Q00000X
Type
Allopathic & Osteopathic Physicians
Taxonomy Description
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.

Group Taxonomy 193200000X MULTI-SPECIALTY GROUP

This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

DONALD W. ANDERSON JR.

Authorized Official Title
ASSISTANT SECRETARY OF ENROLLMENTS
Authorized Official Phone
(425) 358-9786

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
05D0676808
Facility Type
Physician Office
Certificate Effective Date
January 31, 2026
Certificate Expiration Date
January 30, 2028
Laboratory Director
DR. ELIZABETH CULHANE
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Providence Medical Foundation to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1265015978, we treat the final digit (8) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 52. The final step is to find the difference between that total and the next multiple of ten (60 - 52 = 8).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
2
Unchanged
Pos 3
6
Doubled → 12 → 1 + 2
Pos 4
5
Unchanged
Pos 5
0
Doubled → 0
Pos 6
1
Unchanged
Pos 7
5
Doubled → 10 → 1 + 0
Pos 8
9
Unchanged
Pos 9
7
Doubled → 14 → 1 + 4
Check
8
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 6 → 12 → 3 0 → 0 5 → 10 → 1 7 → 14 → 5

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 2 + 1 + 2 + 5 + 0 + 1 + 1 + 0 + 9 + 1 + 4 + 24 = 52

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 52 is 60. The difference is the calculated check digit.

60 - 52 = 8
This NPI is valid
The calculated check digit is 8, which matches the last digit of 1265015978.

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1265015978, enumerated as an "organization" on April 30, 2021.

The provider is located at 185 SOTOYOME ST SANTA ROSA, CA 95405 and the phone number is (707) 303-8355.

Family Medicine with taxonomy code 207Q00000X.