Agewell Pace

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

AGEWELL PACE

Practice address

5789 State Farm Dr Ste 110
Rohnert Park, CA 94928-6308

Phone

(707) 615-4437

Fax

(707) 615-6955

NPI assigned

Jun 9, 2023

Last updated

Jun 9, 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

Derrick Whitacre

Title

Executive Director

Phone

(707) 615-4437

Specialties & licenses 3

Addresses

Locations

Practitioners 2

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.

• Konstanze Emmaline Conradt-Franco, NP

  • Primary Care Nurse Practitioner
  • Petaluma, CA
  • NPI 1972308724
  NPD
• Alexander William Threlfall, MD

  • Psychiatry Physician
  • San Rafael, CA
  • NPI 1669538187
  NPD (past)

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

{
    "created_epoch": "1686268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686268800000",
    "number": "1437833597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5789 STATE FARM DR STE 110",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949286308",
            "telephone_number": "707-615-4437",
            "fax_number": "707-615-6955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5789 STATE FARM DR STE 110",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949286308",
            "telephone_number": "707-615-4437",
            "fax_number": "707-615-6955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGEWELL PACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-09",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A",
        "authorized_official_last_name": "WHITACRE",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "707-615-4437"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• A Healthy Community (Colleen McCoy DC)
• Camille Acedo-Jouzeau, DPT
• Adult Healthcare Advocacy Service (North Bay Ambulance)
• Advanced Pyhsical Medicine and Rehabilitaion Gropu
• Varsha Ahuja, DMD
• Aimee R Aiken, MD
• Cecily Liana Akwari
• Salvador I Alas
• Samantha Quinlan Stone Allen, M.S., LMFT

• General Practice Physician in Rohnert Park, CA
• Providers in Rohnert Park, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; 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.