North Bay Medical Group Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

AS1628 Issued in CA

Legal business name

NORTH BAY MEDICAL GROUP SURGERY CENTER

Practice address

4415 Sonoma Hwy
Suite B
Santa Rosa, CA 95409-7100

Phone

(707) 591-0619

Fax

(707) 591-0617

NPI assigned

Jan 12, 2007

Organization subpart

No

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

Authorized official

Name

Eric James Kraut, M.D.NPI 1255439626

Title

President

Phone

(707) 591-0619

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Ambulatory surgical center certification: CCN 05C0001628

Legal name

NORTH BAY MEDICAL GROUP SURGERY CENTER

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Aug 23, 2003

Last certification

Aug 21, 2003

Ownership / control type

Proprietary

Facility address

4415 Sonoma Hwy, Suite B
Santa Rosa, CA 95409

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eric J. Kraut, M.D.

  • Surgery Physician
  • Owings Mills, MD
  • NPI 1255439626
  NPD (past) Authorized official

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216598400000",
    "number": "1639220189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3850 MONTGOMERY DR",
            "address_2": "SUITE D",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954055207",
            "telephone_number": "707-591-0619",
            "fax_number": "707-591-0617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4415 SONOMA HWY",
            "address_2": "SUITE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954097100",
            "telephone_number": "707-591-0619",
            "fax_number": "707-591-0617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH BAY MEDICAL GROUP SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2008-07-21",
        "status": "A",
        "authorized_official_last_name": "KRAUT",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-591-0619",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "AS1628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• North Bay Cardiology Inc.
• North Bay Eye Associates a Medical Corporation
• North Bay Eye Associates, a Medical Corporation
• North Bay Eye Associates, a Medical Corporation
• North Bay Foot and Ankle Clinic, Inc
• North Bay Medical Group, Inc.
• North Bay Neuropsychology a Psychology Corporation
• North Bay Neurosurgical Associates Medical Group
• North Bay Pain Care
• North Bay Psychiatric Associates Inc

• Ambulatory Surgical Clinic/Center in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.