Individual provider Active NPI

Katrina Carol Groves-Rehwaldt, MD

  • Addiction Medicine (Family Medicine) Physician
  • Walnut Creek, CA
National Provider Identifier
1487748943
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
License
G69202 Issued in CA
Practice address
2960 Camino Diablo Ste 105
Walnut Creek, CA 94597-3945
Phone
(800) 892-2695
NPI assigned
Oct 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) Physician 207QA0401X MD19537 OR
Addiction Medicine (Family Medicine) Physician 207QA0401X G69202 CA Primary

Addresses

Primary practice location

2960 Camino Diablo Ste 105
Walnut Creek, CA 94597-3945

Mailing address

2960 Camino Diablo Ste 105
Walnut Creek, CA 94597-3945
Phone (800) 892-2695

Other names 1

  • Katrina Carol Groves Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, OR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20041215000254 CA Practitioner - Family Practice 2466419023 Reassigns benefits to 1 organization
I20100729000272 OR Practitioner - Family Practice 2466419023 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G69202CAMDAddiction Medicine (Family Medicine) Physician
MD19537ORMDAddiction Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Open Door Community Health Centers CurrentSince Sep 14, 2009 Accepting new patients
Open Door Community Health Centers CurrentSince Sep 14, 2009 Accepting new patients
Peacehealth Current Accepting new patients

Locations

1275 8th St
Arcata, CA 95521

550 E Washington Blvd
Crescent City, CA 95531
Phone (707) 465-4636

1515 Village Dr
Cottage Grove, OR 97424
Phone (541) 767-5200

1515 Village Dr
Ste 200
Cottage Grove, OR 97424
Phone (541) 767-5200

1115 SE 164th Ave
Dept 358
Vancouver, WA 98683
Phone (360) 729-1253

Interoperability endpoints

  • Direct secure messaging: kgrovesrehwaldt367931@direct.peacehealth.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1487748943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2960 CAMINO DIABLO STE 105",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945973945",
            "telephone_number": "800-892-2695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2960 CAMINO DIABLO STE 105",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945973945",
            "telephone_number": "800-892-2695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROVES-REHWALDT",
        "first_name": "KATRINA",
        "middle_name": "CAROL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "OR",
            "license": "MD19537",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "CA",
            "license": "G69202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATRINA",
            "last_name": "GROVES",
            "middle_name": "CAROL",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.