Individual provider Active NPI

Reis Tucker-Meade

  • Primary Care Nurse Practitioner
  • Santa Rosa, CA
National Provider Identifier
1558863779
Registry record updated Oct 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
NP95007608 Issued in CA
Practice address
983 Sonoma Ave
Santa Rosa, CA 95404-4818
Phone
(707) 583-8700
NPI assigned
Mar 3, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X NP95007608 CA Primary

Addresses

Primary practice location

983 Sonoma Ave
Santa Rosa, CA 95404-4818

Mailing address

983 Sonoma Ave
Santa Rosa, CA 95404-4818
Phone (707) 583-8700

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240712000890 CA Practitioner - Nurse Practitioner 1254761125 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP95007608CAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Santa Rosa Community Health Centers CurrentSince May 19, 2024 Accepting new patients
Santa Rosa Community Health Centers CurrentSince May 19, 2024 Accepting new patients
Santa Rosa Community Health Centers Current Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

3569 Round Barn Cir
Santa Rosa, CA 95403

751 Lombardi Ct
Santa Rosa, CA 95407
Phone (707) 547-2222

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1520035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634169600000",
    "number": "1558863779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "983 SONOMA AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044818",
            "telephone_number": "707-583-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "983 SONOMA AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044818",
            "telephone_number": "707-583-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER-MEADE",
        "first_name": "REIS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-03",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "NP95007608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.