NPIMap

Individual provider Active NPI

Ingo O Rencken, M.D.

  • Diagnostic Radiology Physician
  • Sebastopol, CA
National Provider Identifier
1265456776
Registry record updated Apr 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
A56477 Issued in CA
Practice address
501 Petaluma Ave
Sebastopol, CA 95472-4215
Phone
(707) 829-4360
Fax
(707) 829-4013
NPI assigned
Jul 27, 2006
Last updated
Apr 3, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X A56477 CA Primary

Addresses

Primary practice location

501 Petaluma Ave
Sebastopol, CA 95472-4215

Mailing address

PO Box 3222
Napa, CA 94558-0293
Phone (707) 261-7822

Other identifiers 1

IdentifierTypeStateIssuer
00A564770MedicaidCA

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
I20040408001564 CA Practitioner - Diagnostic Radiology 8921092313 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

504 Oak Brook CT
Santa Rosa, CA 95409-6366
Phone (707) 829-4360

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40
Cost
84.14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56477CAMDPediatric Dentist
A56477CAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Turlock Imaging Services, LLC CurrentSince Apr 16, 2024 Accepting new patients
Modesto Radiological Medical Group, Inc. Diagnostic Radiology CurrentSince Jul 1, 2023 Accepting new patients
Valley Radiological Associates Medical Group, Inc. Diagnostic Radiology Past Accepting new patients
Mark Twain Medical Center Past Accepting new patients
Solano Imaging Medical Associates Diagnostic Radiology Past Accepting new patients
Universal Radiology Consultants PC Diagnostic Radiology PastSince Aug 12, 2017 Accepting new patients

Locations

3900 Geer Rd
Turlock, CA 95382
Phone (209) 669-0600

3900 Geer Rd
#1112
Turlock, CA 95382
Phone (209) 669-0600

Organizations & group practices 6

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

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333411200000",
    "number": "1265456776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3222",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945580293",
            "telephone_number": "707-261-7822",
            "fax_number": "707-256-3508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 PETALUMA AVE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724215",
            "telephone_number": "707-829-4360",
            "fax_number": "707-829-4013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENCKEN",
        "first_name": "INGO",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2012-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A56477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A564770",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sebastopol, CA

Sources for this page

Verify at the official NPI Registry.