Dominic J Mintalucci (NPI# 1114126869, PAC ID# 1254574486) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is ORTHOPEDIC SURGERY.
| Nation Provider ID (NPI) | 1114126869 |
| PAC ID by PECOS | 1254574486 |
| Professional Enrollment ID | I20130906000648 |
| Full Name | Dominic J Mintalucci |
| Organization Legal Name | SANTA ROSA ORTHOPAEDIC MEDICAL GROUP, INC. |
| Address |
167 Lynch Creek Way Petaluma CA 94954-2343 |
| Phone Number | 7075461922 |
| Gender | M |
| Medical School | GEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 2007 |
| Primary Specialty | ORTHOPEDIC SURGERY |
| Secondary Specialties | HAND SURGERY |
| Group Practice PAC ID | 4981655057 |
| Number of Group Practice Members | 14 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 050008 | CALIFORNIA PACIFIC MEDICAL CTR-DAVIES CAMPUS HOSP |
| 050174 | SANTA ROSA MEMORIAL HOSPITAL |
| 050301 | ADVENTIST HEALTH UKIAH VALLEY |
| Address | Phone | Organization |
|---|---|---|
| 167 Lynch Creek Way, Petaluma, CA 94954-2343 | 7075461922 | SANTA ROSA ORTHOPAEDIC MEDICAL GROUP, INC. |
| 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 | 7075461922 | SANTA ROSA ORTHOPAEDIC MEDICAL GROUP, INC. |
| Organization Legal Name | SANTA ROSA ORTHOPAEDIC MEDICAL GROUP, INC. |
| Physicians | 14 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Christian N Athanassious | Orthopedic Surgery | Santa Rosa Orthopaedic Medical Group, Inc. | 167 Lynch Creek Way, Petaluma, CA 94954-2343 |
| Thomas Degenhardt | Orthopedic Surgery | Santa Rosa Orthopaedic Medical Group, Inc. | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 |
| Mark Schakel | Orthopedic Surgery | Santa Rosa Orthopaedic Medical Group, Inc. | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 |
| Frederick S Bennett | Orthopedic Surgery | Santa Rosa Orthopaedic Medical Group, Inc. | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 |
| Thomas W Axelrad | Orthopedic Surgery | Santa Rosa Orthopaedic Medical Group, Inc. | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 |
| Rodney G Dekleuver | Physician Assistant | Santa Rosa Orthopaedic Medical Group, Inc. | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 |
| Kai Mazur | Orthopedic Surgery | Santa Rosa Orthopaedic Medical Group, Inc. | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 |
| Patricia Hall | Physical Therapy | Santa Rosa Orthopaedic Medical Group, Inc. | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 |
| Neema Pourtaheri | Orthopedic Surgery | Santa Rosa Orthopaedic Medical Group, Inc. | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 |
| Michael James Mcdermott | Orthopedic Surgery | Santa Rosa Orthopaedic Medical Group, Inc. | 167 Lynch Creek Way, Petaluma, CA 94954-2343 |
| Street Address |
167 LYNCH CREEK WAY |
| City | PETALUMA |
| State | CA |
| Zip | 94954-2343 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Christian N Athanassious | Orthopedic Surgery | Santa Rosa Orthopaedic Medical Group, Inc. | 167 Lynch Creek Way, Petaluma, CA 94954-2343 |
| Michael James Mcdermott | Orthopedic Surgery | Santa Rosa Orthopaedic Medical Group, Inc. | 167 Lynch Creek Way, Petaluma, CA 94954-2343 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Ronald L Harris | Optometry | 1225 N Mcdowell Blvd, Petaluma, CA 94954-1112 | |
| Peter R Pretkel | Psychologist, Clinical | Psych Strategies Inc A Psychological Corp | 1301 Redwood Way, Suite 110, Petaluma, CA 94954-1136 |
| Julie L Restad | Chiropractic | 1301 Redwood Way, Suite 150, Petaluma, CA 94954-1136 | |
| Robert D Mosby | Psychologist, Clinical | Psych Strategies Inc A Psychological Corp | 1301 Redwood Way, Suite 110, Petaluma, CA 94954-1136 |
| Grace A Wakim | Psychologist, Clinical | Psych Strategies Inc A Psychological Corp | 1301 Redwood Way, Suite 110, Petaluma, CA 94954-1136 |
| Dan Lightfoot | Ophthalmology | Eye Care Institute A Medical Corporation | 1383 N Mcdowell Blvd, Suite 100, Petaluma, CA 94954-1190 |
| Kalane J Wong | Ophthalmology | Eye Care Institute A Medical Corporation | 1383 N Mcdowell Blvd, Suite 100, Petaluma, CA 94954-1190 |
| Robert L Anderson | Ophthalmology | Eye Care Institute A Medical Corporation | 1383 N Mcdowell Blvd, Suite 100, Petaluma, CA 94954-1190 |
| Robert A Harf | Orthopedic Surgery | 108 Lynch Creek Way, Suite 7, Petaluma, CA 94954-2310 | |
| Stephen M Gugenheim | Otolaryngology | St Joseph Heritage Healthcare | 108 Lynch Creek Way, Suite 7, Petaluma, CA 94954-2310 |
| Find all physicians in zip 94954 | |||
| City | PETALUMA |
| Zip Code | 94954 |
| Specialty | ORTHOPEDIC SURGERY |
| City + Specialty | PETALUMA + ORTHOPEDIC SURGERY |
Please comment or provide details below to improve the information on Dominic J Mintalucci.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.