NPIMap

Individual provider Active NPI

Dominic J Mintalucci, M.D.

  • Orthopaedic Hand Surgery Physician
  • Santa Rosa, CA
National Provider Identifier
1114126869
Registry record updated Oct 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Hand Surgery PhysicianTaxonomy code 207XS0106X
License
A126421 Issued in CA
Practice address
1405 Montgomery Dr
Santa Rosa, CA 95405-4557
Phone
(707) 546-1922
Fax
(707) 546-1897
NPI assigned
Jul 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X A126421 CA
Orthopaedic Hand Surgery Physician 207XS0106X A126421 CA Primary

Addresses

Primary practice location

1405 Montgomery Dr
Santa Rosa, CA 95405-4557

Mailing address

1405 Montgomery Dr
Santa Rosa, CA 95405-4557
Phone (707) 546-1922

Other identifiers 1

IdentifierTypeStateIssuer
A126421OtherCALICENSE

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
I20130906000648 CA Practitioner - Orthopedic SurgeryPractitioner - Hand Surgery 1254574486 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic SurgeryAlso: Hand Surgery
Education
George Washington University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Santa Rosa Orthopaedic Medical Group IncGroup PAC ID 4981655057, 7 clinicians

Practice addresses (Care Compare)

1701 4TH St
Suite 200
Santa Rosa, CA 95404-3661
Phone (707) 546-1922

Hospital & facility affiliations

  • Sutter Santa Rosa Regional Hospital Hospital, Santa Rosa, CA, CCN 050291
  • Providence Santa Rosa Memorial Hospital Hospital, Santa Rosa, CA, CCN 050174
  • Adventist Health Ukiah Valley Hospital, Ukiah, CA, CCN 050301
  • Petaluma Valley Hospital Hospital, Petaluma, CA, CCN 050136
  • Adventist Health Mendocino Coast Hospital, Fort Bragg, CA, CCN 051325

Merit-based Incentive Payment System (MIPS)

Final score
68.05 of 100Reported as group
Quality
62.72
Promoting interoperability
100
Improvement activities
0
Cost
77.82

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Santa Rosa Orthopaedic Medical Group, Inc. Orthopaedic Surgery CurrentSince Sep 15, 2013 Accepting new patients
Santa Rosa Orthopaedic Medical Group, Inc. Orthopaedic Surgery CurrentSince Sep 15, 2013 Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients

Locations

1405 Montgomery Dr
Santa Rosa, CA 95405
Phone (707) 546-1922

34 Mark West Springs Rd
Ste 300
Santa Rosa, CA 95403
Phone 7075461922 ext. 5453

1701 4th St
Ste 200
Santa Rosa, CA 95404
Phone (707) 525-0100

Interoperability endpoints

  • Direct secure messaging: dmintalucci208931@hisp.ehr.sutterhealth.org

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1184284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380844800000",
    "number": "1114126869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 MONTGOMERY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054557",
            "telephone_number": "707-546-1922",
            "fax_number": "707-546-1897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 MONTGOMERY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054557",
            "telephone_number": "707-546-1922",
            "fax_number": "707-546-1897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINTALUCCI",
        "first_name": "DOMINIC",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-13",
        "last_updated": "2013-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A126421",
            "primary": false
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "CA",
            "license": "A126421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "A126421",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.