Jewish Community Free Clinic

Primary specialty

Public Health or Welfare AgencyTaxonomy code 251K00000X

License

550001029 Issued in CA

Legal business name

JEWISH COMMUNITY FREE CLINIC

Practice address

50 Montgomery Dr
Santa Rosa, CA 95404-6615

Phone

(707) 585-7780

NPI assigned

Dec 29, 2009

Last updated

Sep 10, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donna L Waldman

Title

Executive Director

Phone

(707) 888-0850

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Jewish Community Free Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jewish Community Free Clinic

  • Primary Care Clinic/Center
  • Rohnert Park, CA
  • NPI 1972807949
  NPD tax ID

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Deborah Ann Roberts, FNP

  • Family Nurse Practitioner
  • Santa Rosa, CA
  • NPI 1568113280
  NPD
• Danielle J Daye

  • Family Nurse Practitioner
  • Santa Rosa, CA
  • NPI 1164828828
  NPD (past)
• Peggy Walsh Goebel

  • Family Nurse Practitioner
  • Santa Rosa, CA
  • NPI 1003373440
  NPD (past)
• Arnold Sur-Tsoong Loo, D.O.

  • Internal Medicine Physician
  • Rohnert Park, CA
  • NPI 1063716918
  NPD (past)
• Emily Waters, FNP

  • Family Nurse Practitioner
  • Santa Rosa, CA
  • NPI 1821968009
  NPD (past)
• Elizabeth Anne Woods, NP

  • Nurse Practitioner
  • Rohnert Park, CA
  • NPI 1518969179
  NPD (past)

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

{
    "created_epoch": "1262044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631232000000",
    "number": "1073843819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 MONTGOMERY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954046615",
            "telephone_number": "707-585-7780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 MONTGOMERY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954046615",
            "telephone_number": "707-585-7780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEWISH COMMUNITY FREE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-29",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A",
        "authorized_official_last_name": "WALDMAN",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "707-888-0850"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "CA",
            "license": "550001029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Venus Victoria Jensen
• Donald J. Jereb, MD
• Destiny Chanel Jerkins
• Joanne Jerome, PHARMD
• Dale G Jewell, RPH
• Jewish Family and Children's Services
• Jewish Family and Children's Services
• JGS Pharmacies Inc (Dollar Drug)
• Allison Jhin, DO
• Tingjen Ji, DDS, MSD

• Public Health or Welfare Agency in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Public Health or Welfare Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.