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Deactivated NPI 1174294938 Deactivated / Inactive NPI Male Practitioner

Douglas Peter Davidson , PA

Physician Assistant • San Rafael, CA

✓ Accepts Medicare Assignment
⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Douglas Davidson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 22, 2021
NPI Deactivation Date February 26, 2022
Total Practice Duration ~1 Years of Practice (2022 – 2022)

Professional Overview & Biography Verified Profile Summary

Douglas Davidson, PA was a registered Physician Assistant practicing in San Rafael, CA. Throughout an active medical career spanning 1 years, Douglas Davidson provided care at the practice location at 50 ACACIA AVE until profile deactivation on 2022-02-26.

Douglas Davidson maintained professional affiliations with Dignity Health Medical Foundation, Clinic Services Of California Medical Group Inc and accepted Medicare assignment.

Historical Medicare Part B clinical services included established patient outpatient office visit, emergency department visit for life threatening or functioning severity, emergency department visit with moderate level of medical decision making. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

50 Acacia Ave

San Rafael, CA 949012230

Telephone 9518168970

Medicare Profile & Education

Medical School

Other

Graduation Year

2022

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in San Rafael, CA

Rising Specialist (<5 Yrs)
Practitioner Clinical Experience
4 Yrs -1.3 yrs vs City Avg
City Avg: 5.3 Yrs
State Avg: 11.5 Yrs
Regional Practice Density
44 Specialists

Practicing in San Rafael, CA (14617 Statewide)

Telehealth Adoption Rate
13.6% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
84.6% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Davidson (4 Years) 4 Yrs
San Rafael Specialty Average (5.3 Years) 5.3 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes
41 41 $400.00 $81.82
99285 Emergency department visit for life threatening or functioning severity
31 30 $1224.00 $142.90
99284 Emergency department visit with moderate level of medical decision making
23 15 $832.00 $98.48
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
15 15 $567.00 $115.18
87811 Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19)
15 15 $207.00 $40.55
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention
14 14 $85.56 $13.10
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more
12 12 $523.00 $99.97
81003 Automated urinalysis test
12 11 $29.00 $2.20

Medical Specialties & State Licenses

CMS Verified: 2023-03-07
Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License CA 62399

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Student in an Organized Health Care Education/Training Program

NUCC Taxonomy Code: 390200000X

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Hospital & Practice Group Affiliations

Dignity Health Medical Foundation

2081 Bronze Star Dr, Woodland, CA 957765423

Phone: 5306682600

Clinic Services Of California Medical Group Inc

1235 W Vine St, Lodi, CA 952405144

Phone: 2093343411

Dignity Health Medical Foundation

632 W Gibson Rd, Woodland, CA 956955169

Phone: 5306682600

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Miguel Serrato , ATC OT-C

Physician Assistant

NPI 1013321264

ATCOTC

Michelle Mota

Student in an Organized Health Care Education/Training Program

NPI 1033093703
Thi Tran , PA-C

Physician Assistant

NPI 1033996392

Physician Assistant (Certified)

Emily Gao

Student in an Organized Health Care Education/Training Program

NPI 1093329989
Tricia Ho

Student in an Organized Health Care Education/Training Program

NPI 1104700806
Chantilay Ruffin

Physician Assistant

NPI 1114488814

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

12 Historical Events
👤
Provider Name / Credentials Updated December 28, 2022

Recorded as DOUGLAS DAVIDSON, PA

📍
Updated Practice Location December 05, 2022

Registered at 50 ACACIA AVE, SAN RAFAEL, CA 949012230 (Tel: 9518168970)

📍
Updated Business Mailing Address December 05, 2022

Registered at 38332 MAPLE CT, MURRIETA, CA 925623406 (Tel: 9518168970)

👤
Provider Name / Credentials Updated December 05, 2022

Recorded as DOUGLAS DAVIDSON, DO

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) December 05, 2022

Student in an Organized Health Care Education/Training Program

⚠️
NPI Profile Deactivated February 26, 2022

Record deactivated on February 26, 2022

NPI Profile Active September 22, 2021

NPI status registered as active in NPPES database

📍
Updated Practice Location September 22, 2021

Registered at 50 ACACIA AVE, SAN RAFAEL, CA 949012230 (Tel: 9518168970)

📍
Updated Business Mailing Address September 22, 2021

Registered at 38332 MAPLE CT, MURRIETA, CA 925623406 (Tel: 9518168970)

👤
Provider Name / Credentials Updated September 22, 2021

Recorded as DOUGLAS DAVIDSON, DO

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 22, 2021

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration September 22, 2021

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1174294938
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 22, 2021
Last Update: March 07, 2023
Deactivation Date: February 26, 2022
Sole Proprietor: No

Mailing Address

38332 Maple Ct

Murrieta, CA 925623406

Phone: 9518168970

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.