Renee Dettloff, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

236013 Issued in CA

Practice address

583 Summerfield Rd
Santa Rosa, CA 95405-5239

Phone

(707) 539-1544

NPI assigned

Jan 18, 2017

Sex

Female

Sole proprietor

No

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

Enrolled in CA

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.

Enrollment records 1

Specialty

Certified Nurse Midwife (CNM)

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Group practices

Regents Univ of California UCSFGroup PAC ID 6305160300, 276 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rdettloff220373@direct-ucsfmedicalcenter.org

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.

• Regents Univ of California UCSF

  dba UCSF Physician Group

  • Internal Medicine Physician
  • San Francisco, CA
  • NPI 1124439807
  Medicare reassignment Care Compare group NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Richmond, CA
  • NPI 1235226531
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Marin General Hospital

  • General Acute Care Hospital
  • Greenbrae, CA
  • NPI 1396725677
  NPD (past)
• St. Joseph Health Northern California, LLC

  dba Providence Santa Rosa Memorial Hospital

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1134152549
  NPD (past)
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1740413798
  NPD (past)
• University of California San Francisco

  dba UCSF Medical Center Adult Chronic Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • San Francisco, CA
  • NPI 1992818256
  NPD (past)

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

{
    "created_epoch": "1484697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548288000000",
    "number": "1285170951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 YARBERRY LN",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949541601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "583 SUMMERFIELD RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954055239",
            "telephone_number": "707-539-1544"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "118 E Benton St",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "MI",
            "postal_code": "488382333",
            "country_code": "US",
            "telephone_number": "616-258-2386",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DETTLOFF",
        "first_name": "RENEE",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-18",
        "last_updated": "2019-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "CA",
            "license": "236013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa Lee Desousa, D.O.
• Andrew James Desruisseau, M.D.
• Jamie Detels, LVN
• Sarah Marie Determan, PHD
• Carolyn Detierra, MFT
• Dixie Lee Deuth
• Charlynn Devenny, RASI
• Maureen Ann Devine, MFC
• Patrick Devlin, MD
• James Charles Devore, MD

• Advanced Practice Midwife in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Advanced Practice Midwife in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2019; 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.