Shannon Mentock, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

174978 Issued in CA

Practice address

1179 N McDowell Blvd
Petaluma, CA 94954-6559

Phone

(707) 559-7500

Fax

(707) 559-7620

NPI assigned

May 15, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Wake Forest University School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Petaluma Health Center IncGroup PAC ID 9133180375, shared by 8 NPIs, 76 clinicians

Coastal Health AllianceGroup PAC ID 7315919933, 40 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Petaluma Valley Hospital Hospital, Petaluma, CA, CCN 050136

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: smentock614184@direct.ochin.org

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

• Petaluma Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Petaluma, CA
  • NPI 1588656268
  NPD (past)
• Petaluma Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Rohnert Park, CA
  • NPI 1669870739
  NPD (past)
• SRM Alliance Hospital Services

  • Skilled Nursing Facility
  • Petaluma, CA
  • NPI 1770703886
  NPD (past)

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

• Norcal Healthconnect LLC

  • General Acute Care Hospital
  • Petaluma, CA
  • NPI 1235162645
  Care Compare affiliation

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

{
    "created_epoch": "1494806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647820800000",
    "number": "1104353796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1179 N MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546559",
            "telephone_number": "707-559-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1179 N MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546559",
            "telephone_number": "707-559-7500",
            "fax_number": "707-559-7620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENTOCK",
        "first_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-15",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0063003",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "174978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Menehan, LCSW
• Claudia Menendez
• Myrna Menjivar Gray, DDS
• Joan Marie Menke, MFT
• Sweet Alyssum Mensoff, LMFT
• Celina Allyn Mercer, MD
• Trevor Merrell
• Bethlehem Fekadu Messele
• Alyssa Messer
• Moe Metwalli, PHARMD

• Family Medicine Physician in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2022; 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.
• 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.