NPIMap

Individual provider Active NPI

Elizabeth P Tito, MD

  • Surgery Physician
  • Santa Rosa, CA
National Provider Identifier
1629092309
Registry record updated Nov 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
G148486 Issued in CA
Practice address
121 Sotoyome St Ste 203
Santa Rosa, CA 95405-4822
Phone
(707) 525-6180
Fax
(707) 545-1145
NPI assigned
Jul 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 213256 MA
Surgery Physician 208600000X G148486 CA Primary

Addresses

Primary practice location

121 Sotoyome St Ste 203
Santa Rosa, CA 95405-4822

Mailing address

121 Sotoyome St Ste 203
Santa Rosa, CA 95405-4822

Other identifiers 1

IdentifierTypeStateIssuer
2100746MedicaidMA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address etito1658391@oc.providencedirect.org

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
I20170501002272 CA Practitioner - General SurgeryPractitioner - Other (Physician) 4082501614 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Geisel School of Medicine at Dartmouth, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

10 Woodland Rd
Saint Helena, CA 94574-9554
Phone (707) 967-5721

121 Sotoyome St
Suite 203
Santa Rosa, CA 95405-4822
Phone (707) 546-3141

821 S Saint Helena Hwy
Suite 2
Saint Helena, CA 94574-2266
Phone (707) 968-9232

913 Washington St
Calistoga, CA 94515-1433

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy85
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Apr 24, 2017 Accepting new patients
Adventist Health Physicians Network CurrentSince Apr 1, 2024 Accepting new patients
Adventist Health Physicians Network Current Accepting new patients
St. Helena Hospital Current Accepting new patients
St. Helena Hospital CurrentSince Apr 1, 2024 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Apr 24, 2017 Accepting new patients
Adventist Health Physicians Network CurrentSince Apr 1, 2024 Accepting new patients
Morton Physician Associates Inc Surgery Past Accepting new patients
Steward Medical Group, Inc Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 400
Anaheim, CA 92805

913 Washington St
Calistoga, CA 94515
Phone (707) 942-0844

6 Woodland Rd
Ste 202
Saint Helena, CA 94574
Phone (707) 963-5294

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

121 Sotoyome St
Ste 203
Santa Rosa, CA 95405
Phone (707) 525-4080

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

Organizations & group practices 11

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.

Hospital & facility affiliations 7

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": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1629092309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 SOTOYOME ST STE 203",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 SOTOYOME ST STE 203",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054822",
            "telephone_number": "707-525-6180",
            "fax_number": "707-545-1145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TITO",
        "first_name": "ELIZABETH",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "213256",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "G148486",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2100746",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "etito1658391@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "121 Sotoyome St Ste 203",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954054822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.