Santa Rosa Surgical Services LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SANTA ROSA SURGICAL SERVICES LLC

Practice address

1739 4TH St
Santa Rosa, CA 95404-3601

Phone

(707) 931-5599

Fax

(707) 222-5099

NPI assigned

Jan 26, 2022

Last updated

Nov 4, 2022By 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

Eric Bruntlett

Title

Administrator

Phone

(707) 495-9632

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Santa Rosa Surgical Services LLCCCN 55C0001122

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 4

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.

• Amin Shabbir Azam, CRNA

  • Certified Registered Nurse Anesthetist
  • Oakland, CA
  • NPI 1255808929
  Medicare reassignment NPD
• James Cheng Hsu

  • Certified Registered Nurse Anesthetist
  • Berkeley, CA
  • NPI 1356737936
  Medicare reassignment NPD
• Krishneel Anand Lall, CRNA

  • Certified Registered Nurse Anesthetist
  • Stanford, CA
  • NPI 1164846275
  Medicare reassignment NPD
• Jason Charles Williams, RN CRNA

  • Certified Registered Nurse Anesthetist
  • Santa Clara, CA
  • NPI 1821154949
  Medicare reassignment NPD

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

{
    "created_epoch": "1643155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667520000000",
    "number": "1497407894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1739 4TH ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954043601",
            "telephone_number": "707-931-5599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1739 4TH ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954043601",
            "telephone_number": "707-931-5599",
            "fax_number": "707-222-5099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA ROSA SURGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-26",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A",
        "authorized_official_last_name": "BRUNTLETT",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "707-495-9632"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Santa Rosa Speech & Language Services
• Santa Rosa Speech Therapy, PC (Santa Rosa Speech and Langauge Services)
• Santa Rosa Sports Medicine, Incorporated
• Santa Rosa Surgery Center L P (Santa Rosa Surgery and Endoscopy Center)
• Santa Rosa Surgical Associates
• Santa Rosa Trauma Physicians Medical Group
• Santa Rosa Treatment Program, Inc.
• Santa Rosa Vein Associates, Inc
• Santa Rosaidence Opco, LLC (Santa Rosa Post Acute)
• Janice Santamaria

• Ambulatory Surgical Clinic/Center in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.