Stewart Bernard Perrilliat II, DMIN

Primary specialty

Religious Nonmedical PractitionerTaxonomy code 374K00000X

Practice address

5416 Shallows PL W
Santa Rosa, CA 95409-5502

Phone

(408) 750-4334

Fax

(707) 703-5794

NPI assigned

Oct 15, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Man 2 Man Urban Youth Advocate, Inc

  • Case Management Agency
  • Santa Rosa, CA
  • NPI 1972335255
  NPD Authorized official
• Man to Man - Urban Youth Advocate Inc

  • Voluntary or Charitable Agency
  • Oakland, CA
  • NPI 1295561850
  NPD Authorized official

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

{
    "created_epoch": "1728950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1316767221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5416 SHALLOWS PL W",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954095502",
            "telephone_number": "408-750-4334",
            "fax_number": "707-703-5794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5416 SHALLOWS PL W",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954095502",
            "telephone_number": "408-750-4334",
            "fax_number": "707-703-5794"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7200 Bancroft Ave Ste 266",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946052465",
            "country_code": "US",
            "telephone_number": "408-750-4334",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PERRILLIAT",
        "first_name": "STEWART",
        "middle_name": "BERNARD",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "DMIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-10-15",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "374K00000X",
            "taxonomy_group": "",
            "desc": "Religious Nonmedical Practitioner",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Jo Peringer, MA, LMFT
• Hannah Rose Perlkin
• Arianna Permutt
• Richard P. Permutt, MD
• Brandi Marie Peroney, AGACNP
• Kirsti Perry, LCSW
• Kitti Jean Perry, L.C.S.W.
• Michael W. Perry, D.D.S.
• Stephen Perry, MD
• Sajni Persad

• Religious Nonmedical Practitioner in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Religious Nonmedical Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.