Jerrold Elliott (NPI# 1982854618, PAC ID# 9830251263) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1982854618 |
| PAC ID by PECOS | 9830251263 |
| Professional Enrollment ID | I20160604000075 |
| Full Name | Jerrold Elliott |
| Organization Legal Name | SUTTER WEST BAY MEDICAL FOUNDATION |
| Address |
4702 Hoen Ave Santa Rosa CA 95405-7824 |
| Phone Number | 7075217750 |
| Gender | M |
| Graduation Year | 2008 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 0345145025 |
| Number of Group Practice Members | 346 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 050174 | SANTA ROSA MEMORIAL HOSPITAL |
| 050781 | SONOMA WEST MEDICAL CENTER |
| 050291 | SUTTER SANTA ROSA REGIONAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 4700 Hoen Ave, Santa Rosa, CA 95405-7824 | 7075263360 | SUTTER WEST BAY MEDICAL FOUNDATION |
| 4702 Hoen Ave, Santa Rosa, CA 95405-7824 | 7075217750 | SUTTER WEST BAY MEDICAL FOUNDATION |
| Organization Legal Name | SUTTER WEST BAY MEDICAL FOUNDATION |
| Physicians | 21 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Barry Herman | Obstetrics/gynecology | Sutter West Bay Medical Foundation | 34 Mark W Springs Rd 2nd Floor, Santa Rosa, CA 95403-1436 |
| Samantha Powell | Psychiatry | Sutter West Bay Medical Foundation | 4702 Hoen Ave, Santa Rosa, CA 95405-7824 |
| Susan W Levine | Clinical Psychologist | Sutter West Bay Medical Foundation | 2340 Clay St, San Francisco, CA 94115-1932 |
| Katharine Vieira | Nurse Practitioner | Sutter West Bay Medical Foundation | 4702 Hoen Ave, Santa Rosa, CA 95405-7824 |
| Jason Ullyott | Physician Assistant | Sutter West Bay Medical Foundation | 4700 Hoen Ave, Santa Rosa, CA 95405-7824 |
| Pamela L Blaufarb | Nurse Practitioner | Sutter West Bay Medical Foundation | 3883 Airway Dr, Suite 165, Santa Rosa, CA 95403-1675 |
| Robert R Harrie | General Surgery | Sutter West Bay Medical Foundation | 1315 Alhambra Blvd, Suite 210, Sacramento, CA 95816-5246 |
| Deborah A Magee | Nurse Practitioner | Sutter West Bay Medical Foundation | 4702 Hoen Ave, Santa Rosa, CA 95405-7824 |
| Anne H Easthope | Nurse Practitioner | Sutter West Bay Medical Foundation | 2340 Clay St, San Francisco, CA 94115-1932 |
| Ivan D Hamilton | Internal Medicine | Sutter West Bay Medical Foundation | 2340 Clay St, San Francisco, CA 94115-1932 |
| Street Address |
4702 HOEN AVE |
| City | SANTA ROSA |
| State | CA |
| Zip | 95405-7824 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Samantha Powell | Psychiatry | Sutter West Bay Medical Foundation | 4702 Hoen Ave, Santa Rosa, CA 95405-7824 |
| Katharine Vieira | Nurse Practitioner | Sutter West Bay Medical Foundation | 4702 Hoen Ave, Santa Rosa, CA 95405-7824 |
| Deborah A Magee | Nurse Practitioner | Sutter West Bay Medical Foundation | 4702 Hoen Ave, Santa Rosa, CA 95405-7824 |
| Raymond Freitas | Family Practice | Sutter West Bay Medical Foundation | 4702 Hoen Ave, Santa Rosa, CA 95405-7824 |
| Locke Louis Wilson | Family Practice | Sutter West Bay Medical Foundation | 4702 Hoen Ave, Santa Rosa, CA 95405-7824 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Larry Marianella | Internal Medicine | 1515 Montgomery Dr, Santa Rosa, CA 95405-4500 | |
| Jean Claude Bassila | Nephrology | 435 Doyle Park Dr, Santa Rosa, CA 95405-4515 | |
| Michael G Carlston | Family Medicine | 427 Doyle Park Dr, Santa Rosa, CA 95405-4515 | |
| Stephen Lee | Nephrology | Santa Rosa Kidney Care PC | 435 Doyle Park Dr, Santa Rosa, CA 95405-4515 |
| Eric Schmidt | Orthopedic Surgery | 525 Doyle Park Dr, Suite 101, Santa Rosa, CA 95405-4516 | |
| Marc E Thorne | Physician Assistant | Eric S Schmidt, Md, Inc | 525 Doyle Park Dr, Santa Rosa, CA 95405-4516 |
| Tomas Vasiliauskas | Cardiovascular Disease (cardiology) | St Joseph Heritage Healthcare | 500 Doyle Park Dr, Santa Rosa, CA 95405-4555 |
| Priscilla T Ngo | Nurse Practitioner | St Joseph Heritage Healthcare | 500 Doyle Park Dr, Suite 303, Santa Rosa, CA 95405-4555 |
| Jaya R Mallidi | Cardiovascular Disease (cardiology) | St Joseph Heritage Healthcare | 500 Doyle Park Dr, Suite G05, Santa Rosa, CA 95405-4555 |
| Marlon C Decastro | Internal Medicine | St Joseph Heritage Healthcare | 500 Doyle Park Dr, Suite 303, Santa Rosa, CA 95405-4555 |
| Find all physicians in zip 95405 | |||
| City | SANTA ROSA |
| Zip Code | 95405 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | SANTA ROSA + PHYSICIAN ASSISTANT |
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| 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.