NPIMap

Individual provider Active NPI

Paul Viscogliosi, PA

  • Medical Physician Assistant
  • Santa Rosa, CA
National Provider Identifier
1538662937
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
55373 Issued in CA
Practice address
3883 Airway Dr Ste 165
Santa Rosa, CA 95403-1675
Phone
(707) 521-7799
Fax
(707) 573-5431
NPI assigned
Mar 12, 2018
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 55373 CA Primary
Surgical Physician Assistant 363AS0400X 55373 CA

Addresses

Primary practice location

3883 Airway Dr Ste 165
Santa Rosa, CA 95403-1675

Mailing address

213 Chris St
Windsor, CA 95492-8631
Phone (925) 381-3790

Other practice location 1

30 Mark West Springs Rd
Santa Rosa, CA 95403-1436
Phone (707) 576-4000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180530000895 CA Practitioner - Physician Assistant 5496010167 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Tufts University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

30 Mark W Springs Rd
Santa Rosa, CA 95403-1436
Phone (707) 576-4500

34 Mark W Springs Rd
Santa Rosa, CA 95403-1436

3883 Airway Dr
Santa Rosa, CA 95403-1671

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince May 8, 2018 Accepting new patients
Sutter Bay Medical Foundation CurrentSince May 8, 2018 Accepting new patients
Sutter Bay Medical Foundation Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients

Locations

3883 Airway Dr
Ste 220
Santa Rosa, CA 95403
Phone (707) 521-7750

30 Mark West Springs Rd
Santa Rosa, CA 95403
Phone (707) 576-4000

3883 Airway Dr
Ste 165
Santa Rosa, CA 95403
Phone (707) 521-7799

Interoperability endpoints

  • Direct secure messaging: pviscogliosi292740@hisp.ehr.sutterhealth.org

Organizations & group practices 4

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1520812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1538662937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 CHRIS ST",
            "city": "WINDSOR",
            "state": "CA",
            "postal_code": "954928631",
            "telephone_number": "925-381-3790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3883 AIRWAY DR STE 165",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031675",
            "telephone_number": "707-521-7799",
            "fax_number": "707-573-5431"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30 Mark West Springs Rd",
            "address_purpose": "LOCATION",
            "city": "Santa Rosa",
            "state": "CA",
            "postal_code": "954031436",
            "country_code": "US",
            "telephone_number": "707-576-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VISCOGLIOSI",
        "first_name": "PAUL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-12",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "55373",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "55373",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.