NPIMap

Sutter Medical Foundation

Organization Active NPI Internal Medicine Physician · Santa Rosa, CA

NPI 1710162292 · NPPES record last updated Mar 18, 2026

Key facts

NPI
1710162292
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
SUTTER MEDICAL FOUNDATION
Practice address
625 Steele LN
Santa Rosa, CA 95403-3127
Phone
(707) 576-4828
NPI assigned
Jan 3, 2008
Organization subpart
Yes
Parent organization (as reported)
SUTTER HEALTH

Authorized official

Name
Kristin Keller
Title
Sr. Director, Planning and Alignmen
Phone
(650) 934-7000

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Practitioners 40

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

View all 40

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20090311000335 CA Part B Supplier - Clinic/Group Practice 9830094515 Receives reassigned benefits from 3,204 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

National Provider Directory

Part of
Sutter Health Shared Laboratory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X Yes
Diagnostic Radiology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2085R0202X
Diagnostic Ultrasound Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2085U0001X
Radiologic Technologist
Group: 193200000X MULTI-SPECIALTY GROUP		 247100000X
Mammography Radiologic Technologist
Group: 193200000X MULTI-SPECIALTY GROUP		 2471M2300X
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

625 Steele LN
Santa Rosa, CA 95403-3127

Mailing address

3883 Airway Dr
Suite 300
Santa Rosa, CA 95403-1670
Phone (707) 576-4828

Other names

  • Sutter Medical Foundation North Bay Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 18, 2026.

{
    "created_epoch": "1199318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773792000000",
    "number": "1710162292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3883 AIRWAY DR",
            "address_2": "SUITE 300",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031670",
            "telephone_number": "707-576-4828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 STEELE LN",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033127",
            "telephone_number": "707-576-4828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUTTER HEALTH",
        "enumeration_date": "2008-01-03",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "SR. DIRECTOR, PLANNING AND ALIGNMEN",
        "authorized_official_telephone_number": "650-934-7000"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "247100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471M2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Mammography",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sutter Medical Foundation North Bay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

All providers in Santa Rosa, CA · Internal Medicine Physician in California

Sources for this page

Verify at the official NPI Registry.