NPIMap

Individual provider Active NPI

Kevin Michael Li, MD

  • Adult Medicine Physician
  • Santa Rosa, CA
National Provider Identifier
1619186764
Registry record updated Aug 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
A98063 Issued in CA
Practice address
1300 N Dutton Ave
Santa Rosa, CA 95401-7112
Phone
(707) 396-5151
NPI assigned
May 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A98063 CA
Adult Medicine Physician 207QA0505X A98063 CA Primary

Addresses

Primary practice location

1300 N Dutton Ave
Santa Rosa, CA 95401-7112

Mailing address

1300 N Dutton Ave
Santa Rosa, CA 95401-7112
Phone (707) 396-5151

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
I20090224000350 CA Practitioner - Family Practice 9133284250 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Georgetown University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Asian Health ServicesGroup PAC ID 0244271021, 93 clinicians

Practice addresses (Care Compare)

250 E 18TH St
FL 2
Oakland, CA 94606-1716
Phone (510) 735-3888

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.2 of 100Reported as group
Quality
61.12
Promoting interoperability
99
Improvement activities
40
Cost
83.72

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A98063CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Asian Health Services CurrentSince Oct 17, 2024 Accepting new patients
Santa Rosa Community Health Centers CurrentSince Aug 18, 2023 Accepting new patients
Asian Health Services CurrentSince Oct 17, 2024 Accepting new patients
Santa Rosa Community Health Centers CurrentSince Aug 18, 2023 Accepting new patients
Santa Rosa Community Health Centers Current Accepting new patients
Asian Health Services Current Accepting new patients
City and County of San Francisco CurrentSince Feb 10, 2018 Accepting new patients
City & County of San Francisco CurrentSince Feb 10, 2018 Accepting new patients
City & County of San Francisco Current Accepting new patients

Locations

250 E 18th St
Fl 2
Oakland, CA 94606
Phone (510) 735-3888

818 Webster St
Oakland, CA 94607
Phone (510) 986-6800

101 8th St
Ste 100
Oakland, CA 94607
Phone (510) 735-3100

1490 Mason St
San Francisco, CA 94133
Phone (415) 364-7600

1001 Potrero Ave
Bldg 20
San Francisco, CA 94110
Phone (415) 206-8524

1351 24th Ave
San Francisco, CA 94122
Phone (415) 682-1900

2401 Keith St
San Francisco, CA 94124
Phone (415) 671-7000

1300 N Dutton Ave
Santa Rosa, CA 95401
Phone (707) 303-3395

3569 Round Barn Cir
Santa Rosa, CA 95403

Interoperability endpoints

  • Direct secure messaging: kli758504@direct.ochin.org

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

Hospital & facility affiliations 5

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": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1619186764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 N DUTTON AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954017112",
            "telephone_number": "707-396-5151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N DUTTON AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954017112",
            "telephone_number": "707-396-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LI",
        "first_name": "KEVIN",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A98063",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CA",
            "license": "A98063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.