Elyse R. Eisenberg MD, Inc.

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

G64542 Issued in CA

Legal business name

ELYSE R. EISENBERG MD, INC.

Practice address

725 Farmers LN Ste 10
Santa Rosa, CA 95405-6743

Phone

(707) 575-5355

Fax

(866) 870-0815

NPI assigned

Jul 13, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Elyse Rae Eisenberg, M.D.NPI 1316966815

Title

Ceo and President

Phone

(707) 575-5355

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Elyse Eisenberg, MD Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Elyse Eisenberg MD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Elyse R. Eisenberg, MD, Inc.

  • Clinic/Center
  • Santa Rosa, CA
  • NPI 1003225061
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elyse Rae Eisenberg, M.D.

  • Addiction Medicine (Family Medicine) Physician
  • Santa Rosa, CA
  • NPI 1316966815
  Medicare reassignment NPD Authorized official
• David L. Green, PH.D.

  • Clinical Psychologist
  • Fairfield, CA
  • NPI 1518041771
  NPD (past)

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

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491782400000",
    "number": "1497954911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 FARMERS LN STE 10",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954056743",
            "telephone_number": "707-575-5355",
            "fax_number": "866-870-0815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 FARMERS LN STE 10",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954056743",
            "telephone_number": "707-575-5355",
            "fax_number": "866-870-0815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELYSE R. EISENBERG MD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-13",
        "last_updated": "2017-04-10",
        "status": "A",
        "authorized_official_last_name": "EISENBERG",
        "authorized_official_first_name": "ELYSE",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "CEO AND PRESIDENT",
        "authorized_official_telephone_number": "707-575-5355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "CA",
            "license": "G64542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP'S NPI",
            "identifier": "14979554911",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elyse Eisenberg, MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Michael Ethen Ellison
• Erin Elo
• Kirk Elrod
• Garrett Joesph Elsberry
• Kelly Ann Elward, D.D.S.
• Elyse R. Eisenberg, MD, Inc.
• Lela M Emad, M.D.
• Hila Emanuel-Cohen, LMFT
• Emericare Inc
• Joshua James Emerick

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.