NPIMap

Individual provider Active NPI

Dominic Joseph Picetti, MD

  • Internal Medicine Physician
  • Santa Rosa, CA
National Provider Identifier
1013413517
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A164045 Issued in CA
Practice address
30 Mark West Springs Rd
Santa Rosa, CA 95403-1436
Phone
(707) 576-4000
NPI assigned
Apr 3, 2018
Last updated
Jun 21, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A164045 CA Primary

Addresses

Primary practice location

30 Mark West Springs Rd
Santa Rosa, CA 95403-1436

Mailing address

601 Van Ness Ave Ste E3619
San Francisco, CA 94102-3200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210728001183 CA Practitioner - HospitalistPractitioner - Internal Medicine 8325441363 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
University of Arkansas College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific Inpatient Medical GroupGroup PAC ID 6608956966, 128 clinicians

Practice addresses (Care Compare)

3555 Cesar Chavez
San Francisco, CA 94110-4403
Phone (415) 485-8824

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A164045CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health Internal Medicine Current Accepting new patients
Pacific Inpatient Medical Group Internal Medicine CurrentSince Aug 1, 2022 Accepting new patients
Scripps Health CurrentSince Aug 1, 2021 Accepting new patients
Scripps Health Internal Medicine CurrentSince Aug 1, 2021 Accepting new patients

Locations

10666 N Torrey Pines Rd
La Jolla, CA 92037
Phone (858) 554-2626

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

9898 Genesee Ave
La Jolla, CA 92037
Phone (858) 824-5222

File 54433
Los Angeles, CA 90074
Phone (858) 784-5645

10790 Rancho Bernardo Rd
San Diego, CA 92127
Phone (858) 554-2626

1101 Van Ness Ave
San Francisco, CA 94109
Phone (415) 485-8824

3555 Cesar Chavez
San Francisco, CA 94110
Phone (415) 485-8824

601 Van Ness Ave
Ste E3619
San Francisco, CA 94102
Phone (415) 531-9047

Interoperability endpoints

  • Direct secure messaging: dpicetti624764@hisp.ehr.sutterhealth.org

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Redwoods, a Community of SeniorsMill Valley, CA, CCN 555826 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 1, 2023
Feb 7, 2025
Sonoma Post AccuteSonoma, CA, CCN 055268 Skilled nursing facility Contracted Managing Employee Mar 1, 2024
Santa Rosa Post AcuteSanta Rosa, CA, CCN 055854 Skilled nursing facility Contracted Managing Employee Mar 1, 2024
Marin Post AcuteSan Rafael, CA, CCN 055310 Skilled nursing facility Contracted Managing Employee Mar 1, 2024
Ridgeway Post AcutePetaluma, CA, CCN 555703 Skilled nursing facility Contracted Managing Employee Mar 1, 2024

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1013413517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 VAN NESS AVE STE E3619",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941023200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 MARK WEST SPRINGS RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031436",
            "telephone_number": "707-576-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICETTI",
        "first_name": "DOMINIC",
        "middle_name": "JOSEPH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-03",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A164045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.