NPIMap

Individual provider Active NPI

Albert Peng, M.D.

  • MOHS-Micrographic Surgery Physician
  • Santa Rosa, CA
National Provider Identifier
1609862820
Registry record updated Feb 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
A75807 Issued in CA
Practice address
2725 Mendocino Ave
Santa Rosa, CA 95403-2805
Phone
(707) 545-4537
Fax
(707) 545-6726
NPI assigned
Sep 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X A75807 CA
Procedural Dermatology Physician 207NS0135X A75807 CA
MOHS-Micrographic Surgery Physician 207ND0101X A75807 CA Primary

Addresses

Primary practice location

2725 Mendocino Ave
Santa Rosa, CA 95403-2805

Mailing address

2725 Mendocino Ave
Santa Rosa, CA 95403-2805
Phone (707) 542-6313

Other identifiers 2

IdentifierTypeStateIssuer
1609862820MedicaidCA
P01774450OtherCARAILROAD MEDICARE

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
I20031219000858 CA Practitioner - Dermatology 8325946924 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Jefferson Medical College of Thomas Jefferson University, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
David J. Macgregor, M.D., ApcGroup PAC ID 9931104411, 2 clinicians
Joseph H Greenberg LTD a Medical CorpGroup PAC ID 3678765971, 4 clinicians

Practice addresses (Care Compare)

2725 Mendocino Ave
Santa Rosa, CA 95403-2805
Phone (707) 545-4537

450 Sutter St
RM 1824
San Francisco, CA 94108-4111
Phone (415) 989-9400

750 Las Gallinas Ave
Suite 205
San Rafael, CA 94903-3432
Phone (415) 472-3903

Merit-based Incentive Payment System (MIPS)

Final score
92.97 of 100Reported as group
Quality
100
Improvement activities
40
Cost
76.57

Merit-based Incentive Payment System (MIPS)

Final score
54.26 of 100Reported as individual
Quality
39.2
Promoting interoperability
59
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision190
Removal of tissue1-10
Removal of skin lesions593
Removal of skin cancer1817
Removal of nail tissue1-10
Skin biopsy243

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A75807CAMDMOHS-Micrographic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
David J. Macgregor, M.D., Apc Dermatology CurrentSince Jan 14, 2021 Accepting new patients
Hma Santa Rosa Medical Center LLC Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
California Pacific Medical Group, Inc. Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
UCSF Health Community Hospitals Past Accepting new patients

Locations

450 Sutter St
Rm 1824
San Francisco, CA 94108
Phone (415) 392-4925

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1197/brand/1/csg/1/fhir/r4
  • Direct secure messaging: apeng@rfd.emadirect.md

Organizations & group practices 9

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": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1609862820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 MENDOCINO AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032805",
            "telephone_number": "707-542-6313",
            "fax_number": "075-456-7267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2725 MENDOCINO AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032805",
            "telephone_number": "707-545-4537",
            "fax_number": "707-545-6726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENG",
        "first_name": "ALBERT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-22",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A75807",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A75807",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "A75807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609862820",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01774450",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.