Individual provider Active NPI

Anna Baylor

  • Family Medicine Physician
  • Santa Rosa, CA
National Provider Identifier
1538218433
Registry record updated Jun 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G72855 Issued in CA
Practice address
499 Humboldt St Ste 104
Santa Rosa, CA 95404-4214
Phone
(707) 565-7407
NPI assigned
Jan 9, 2007
Last updated
Jun 27, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G72855 CA Primary

Addresses

Primary practice location

499 Humboldt St Ste 104
Santa Rosa, CA 95404-4214

Mailing address

499 Humboldt St Ste 104
Santa Rosa, CA 95404-4214

Other identifiers 1

IdentifierTypeStateIssuer
00G7285500MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20080724000913 CA Practitioner - Family PracticePractitioner - Other (Physician) 6103999057 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G72855CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Petaluma Health Center, Inc CurrentSince Mar 1, 2016 Accepting new patients
Petaluma Health Center Inc CurrentSince Mar 1, 2016 Accepting new patients
County of Sonoma Past Accepting new patients

Locations

1179 N McDowell Blvd
Petaluma, CA 94954

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403827200000",
    "number": "1538218433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "499 HUMBOLDT ST STE 104",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499 HUMBOLDT ST STE 104",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044214",
            "telephone_number": "707-565-7407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAYLOR",
        "first_name": "ANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-09",
        "last_updated": "2014-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G72855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G7285500",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.