EL ROSE MEDICAL GROUP (NPI# 1902976236) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902976236 |
| Entity Type | Organization |
| Organization Name | EL ROSE MEDICAL GROUP |
| Practice Address |
24 West El Rose Ave Petaluma CA 94952 |
| Practice Telephone | 7077639891 |
| Practice Fax Number | 7077639896 |
| Mailing Telephone | 7077639891 |
| Mailing Fax Number | 7077639896 |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2008-07-08 |
| Authorized Official Name | MR. DAVID A SISLER (OWNER) |
| Authorized Official Telephone | 7077639491 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RAILROAD MEDICARE | CP6140 | 01 | |
| BLUE CROSS BLUE SHIELD | AROSE0543 | 01 | |
| STATE LICENSE # | C26495 | 01 | |
| MEDI CAL GRP # | ZZZ75987Z | 01 | |
| STATE LICENSE # | G21106 | 01 | |
| STATE LICENSE # | C17753 | 01 | |
| MEDI CAL | ZZZ75987Z | 01 |
| Street Address |
24 WEST EL ROSE AVE |
| City | PETALUMA |
| State | CA |
| Zip Code | 94952 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114587680 | Benjamin R Idarius | Behavior Technician | 101 H St. Ste. L, Petaluma, CA 94952 | 2019-06-17 |
| 1518457159 | Kyleen Joan Romero | Behavioral Analyst | 25 Graylawn Ave, Petaluma, CA 94952 | 2018-05-17 |
| 1437647526 | John Scruggs | Behavior Technician | 301 H St. Suit L, Petaluma, CA 94952 | 2018-04-25 |
| 1811404684 | Brief and Strategic Counseling Service | Counselor | 843 Chardonnay Cir., Petaluma, CA 94952 | 2018-01-03 |
| 1730638396 | Jennifer Lee Sloan | Acupuncturist | 517 Hayes Lane, Petaluma, CA 94952 | 2016-09-23 |
| 1982057295 | Elene Hwa-yihg Chung | Acupuncturist | 130 Graylawn Ave.,#f, Petaluma, CA 94952 | 2016-07-21 |
| 1457773624 | Lisa Hirsch Cordeiro | Marriage & Family Therapist | 700 Sixth Street, Petaluma, CA 94952 | 2014-01-07 |
| 1811271075 | Jacques Philippe Archer | Massage Therapist | 131b Kentucky St., Petaluma, CA 94952 | 2011-10-06 |
| 1477841609 | Karna Licia Dawson | Social Worker | 205 Keller St., Petaluma, CA 94952 | 2011-07-21 |
| 1497051783 | Melissa Beth Wilson | Acupuncturist | 155a Kentucky Street, Petaluma, CA 94952 | 2011-02-03 |
| Find all providers in zip 94952 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| 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. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669719043 | Roger Evan Minkow | Family Medicine | 735 H St, Petaluma, CA 94952-4936 | 2013-01-06 |
| 1285994244 | Tam Tiet | Family Medicine | 1383 N Mcdowell Blvd Ste 150, Petaluma, CA 94954 | 2012-05-24 |
| 1750472213 | Brian Bouch | Family Medicine | 616 Petaluma Blvd N, Suite C, Petaluma, CA 94952-2847 | 2006-09-27 |
| 1023043494 | Lana Ngoc Nguyen | Family Medicine | 3835 Cypress Dr, Suite 102, Petaluma, CA 94954-6965 | 2006-07-12 |
| 1083606776 | Kelly Pfeifer | Family Medicine | 1301 Southpoint Blvd, Petaluma, CA 94954-6858 | 2005-08-18 |
| 1013919190 | Daniel G White | Family Medicine | 3900 Lakeville Hwy, Petaluma, CA 94954-5698 | 2005-08-10 |
| 1366445785 | Michelle Davey | Family Medicine | 1179 N Mcdowell Blvd, Petaluma, CA 94954 | 2005-05-31 |
| 1588220636 | Northern California Medical Assoc | Family Medicine | 1116 B St, Petaluma, CA 94952-4054 | 2019-05-14 |
| 1427508241 | Ulysses Gomez | Family Medicine | 1179 N Mcdowell Blvd, Petaluma, CA 94954 | 2016-10-05 |
| 1801281027 | Scott Holmes | Family Medicine | 1179 N Mcdowell Blvd, Petaluma, CA 94954 | 2015-04-03 |
| Find all providers in PETALUMA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.