Charles William Pengra, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY 6754 Issued in CA

Practice address

722 Spring St
Ste. 1
Santa Rosa, CA 95404-3902

Phone

(707) 583-2360

Fax

(707) 544-0825

NPI assigned

Jul 25, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2016 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093738619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "722 SPRING ST",
            "address_2": "STE. 1",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954043902",
            "telephone_number": "707-583-2360",
            "fax_number": "707-544-0825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 SPRING ST",
            "address_2": "STE. 1",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954043902",
            "telephone_number": "707-583-2360",
            "fax_number": "707-544-0825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENGRA",
        "first_name": "CHARLES",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY 6754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lawrence Peltz
• Van Arthur Pena, PH.D., M.D.
• Albert Peng, M.D.
• Jonathan A. Peng, M.D.
• Emily G Pengelly, PA-C, MD
• Tom Penland
• Daniel R. Penn, MD
• Esther A. Penn, MD
• Aleae T. Pennette, DC,
• Gregory P Penning, R.T.(R)(CT)ARRT

• Psychologist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.