Sutter West Bay Medical Foundation

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SUTTER WEST BAY MEDICAL FOUNDATION

Doing business as

Sutter Pacific Medical Foundation

Practice address

3883 Airway Drive
Suite 120
Santa Rosa, CA 95403-1678

Phone

(707) 521-8966

Fax

(707) 523-1301

NPI assigned

Oct 14, 2009

Last updated

May 21, 2010By the provider in NPPES

Organization subpart

Yes

Parent organization

SUTTER WEST BAY MEDICAL FOUNDATIONAs reported in NPPES

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

Authorized official

Name

John B. Gates

Title

Chief Financial Officer

Phone

41560007771

Specialties & licenses 15

Addresses

Other identifiers 3

Other names 1

• Sutter Pacific Medical Foundation Doing business as

Part of

Sutter West Bay Med Found

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Sutter West Bay Medical Foundation

  dba Sutter Pacific Medical Foundation

  • Family Medicine Physician
  • San Francisco, CA
  • NPI 1104852789
  NPPES parent name

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

{
    "created_epoch": "1255478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274400000000",
    "number": "1346575073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 CALIFORNIA STREET",
            "address_2": "SUITE 530",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941094591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3883 AIRWAY DRIVE",
            "address_2": "SUITE 120",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031678",
            "telephone_number": "707-521-8966",
            "fax_number": "707-523-1301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER WEST BAY MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUTTER WEST BAY MEDICAL FOUNDATION",
        "enumeration_date": "2009-10-14",
        "last_updated": "2010-05-21",
        "status": "A",
        "authorized_official_last_name": "GATES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "41560007771"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "247100000X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0055425",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR00055421",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0091420",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sutter Pacific Medical Foundation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sutter Valley Medical Foundation
• Sutter Valley Medical Foundation
• Sutter Visiting Nurse Association and Hospice (Sutter Care at Home)
• Sutter Visiting Nurse Association and Hospice (Sutter Care at Home)
• Sutter West Bay Medical Foundation (Sutter Pacific Medical Foundation)
• Sutter West Bay Medical Foundation (Endoscopy Center of Santa Rosa)
• Sutton Dental Practice Inc.
• Donna Sutton
• Foxine Michelle Sutton
• Jesse Sutton

• Family Medicine Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2010; 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.