NPIMap

Organization Active NPI

Sutter Medical Group of the Redwoods

  • Diagnostic Radiology Physician
  • Santa Rosa, CA
National Provider Identifier
1508052572
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SUTTER MEDICAL GROUP OF THE REDWOODS
Practice address
625 Steele LN
Santa Rosa, CA 95403-3127
Phone
(707) 576-4800
Fax
(707) 576-4825
NPI assigned
Sep 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Lisa M Phillips
Title
Credentialing Specialist
Phone
(707) 473-4531

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X CA Primary

Addresses

Primary practice location

625 Steele LN
Santa Rosa, CA 95403-3127

Mailing address

15620 Healdsburg Ave
Healdsburg, CA 95448-9617
Phone (707) 473-4531

National Provider Directory

National Provider Directory
Tax ID family
Sutter Medical Group of the Redwoods5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1508052572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15620 HEALDSBURG AVE",
            "city": "HEALDSBURG",
            "state": "CA",
            "postal_code": "954489617",
            "telephone_number": "707-473-4531",
            "fax_number": "707-473-4559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 STEELE LN",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033127",
            "telephone_number": "707-576-4800",
            "fax_number": "707-576-4825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER MEDICAL GROUP OF THE REDWOODS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-24",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "707-473-4531"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.