Santa Rosa Treatment Program, Inc.

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

License

49-02 Issued in CA

Legal business name

SANTA ROSA TREATMENT PROGRAM, INC.

Practice address

625 Steele Lane
Santa Rosa, CA 95403-3127

Phone

(707) 576-0818

Fax

(707) 576-7845

NPI assigned

Jul 7, 2005

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Lee Roy Tillman

Title

Program Director/Ceo

Phone

(707) 576-0818

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in CA

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daniel Steven Calder, MD

  • Addiction Medicine (Preventive Medicine) Physician
  • Santa Rosa, CA
  • NPI 1629056130
  NPD (past)

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1285631978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 STEELE LANE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033127",
            "telephone_number": "707-576-0818",
            "fax_number": "707-576-7845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 STEELE LANE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033127",
            "telephone_number": "707-576-0818",
            "fax_number": "707-576-7845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA ROSA TREATMENT PROGRAM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "TILLMAN",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "ROY",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR/CEO",
        "authorized_official_telephone_number": "707-576-0818",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "CA",
            "license": "49-02",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDD STATE PROVIDER",
            "identifier": "3631909",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSAT (SAMHSA)",
            "identifier": "CA-10228-M",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHCS NTP",
            "identifier": "49-02",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "49AC",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Santa Rosa Sports Medicine, Incorporated
• Santa Rosa Surgery Center L P (Santa Rosa Surgery and Endoscopy Center)
• Santa Rosa Surgical Associates
• Santa Rosa Surgical Services LLC
• Santa Rosa Trauma Physicians Medical Group
• Santa Rosa Vein Associates, Inc
• Santa Rosaidence Opco, LLC (Santa Rosa Post Acute)
• Janice Santamaria
• Dulce Samantha Santana Gonzalez, FNP-C
• Noemi Santana, MD

• Methadone Clinic in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Methadone Clinic in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.