Roger Samuel Proctor, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

G46210 Issued in CA

Practice address

1700 San Pablo Ave
Pinole, CA 94564-2081

Phone

(510) 724-9500

Fax

(510) 724-9511

NPI assigned

Jan 31, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Anesthesiology

Education

Loma Linda University School of Medicine, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Monterey Anesthesia ProfessionalsGroup PAC ID 6002047164, 17 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Natividad Medical Center Hospital, Salinas, CA, CCN 050248

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Monterey Anesthesia Professionals

  • Anesthesiology Physician
  • Salinas, CA
  • NPI 1073935250
  Medicare reassignment Care Compare group NPD

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

• County of Monterey

  • General Acute Care Hospital
  • Salinas, CA
  • NPI 1205863255
  Care Compare affiliation

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420848000000",
    "number": "1184761090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 N TUSTIN AVE",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927053807",
            "telephone_number": "714-347-1010",
            "fax_number": "714-647-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 SAN PABLO AVE",
            "city": "PINOLE",
            "state": "CA",
            "postal_code": "945642081",
            "telephone_number": "510-724-9500",
            "fax_number": "510-724-9511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "ROGER",
        "middle_name": "SAMUEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2015-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G46210",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G462100",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pinole Podiatry Group Inc
• Steve Polonsky
• Angelica Portillo
• Denise Portillo
• Priya Patel Dental Corporation
• John Myunghoon Pyun, MD
• Rongting Qu, DPT
• Henry Quayson
• William Quibell
• Lawrence Alfred Radcliffe, DDS

• Anesthesiology Physician in Pinole, CA
• Providers in Pinole, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2015; 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.