Dustin K Wetmore, PA-C
Individual provider Active NPI Physician Assistant · Santa Rosa, CA
NPI 1710320437 · NPPES record last updated Nov 11, 2021
Key facts
- NPI
- 1710320437
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA22901 (CA)
- Practice address
- 121 Sotoyome St Ste 201
Santa Rosa, CA 95405 - Phone
- (707) 308-3101
- Fax
- (707) 546-4062
- NPI assigned
- Apr 11, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Providence Medical Foundation
Practice addresses (Care Compare)
1165 Montgomery Dr
Santa Rosa, CA 95405-4801
Phone (707) 546-3210
500 Doyle Park Dr
Santa Rosa, CA 95405-4559
Hospital & facility affiliations
- Providence Santa Rosa Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150413002515 | CA | Practitioner - Physician Assistant | 0941528434 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA22901 | CA | MD | Physician Assistant |
| 22901 | CA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Healthcare Network | Current |
Accepting new patients | |
| Spectrumcare Rehabilitation Medical Center | Physician Assistant | Current |
Accepting new patients |
| Family Healthcare Network | Current |
Accepting new patients | |
| Family Healthcare Network | Current | Accepting new patients | |
| Providence Medical Foundation | Current |
Accepting new patients | |
| Providence Medical Foundation | Current |
Accepting new patients |
Locations
905 E Washington St
Petaluma, CA 94952
Phone (707) 763-9891
500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842
1221 Farmers Ln
Ste 500
Santa Rosa, CA 95405
Phone (707) 308-3101
121 Sotoyome St
Ste 201
Santa Rosa, CA 95405
Phone (707) 293-3845
1165 Montgomery Dr
Santa Rosa, CA 95405
Phone (707) 525-5300
1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210
400 E Oak Ave
Visalia, CA 93291
Phone (559) 741-4500
305 E Center Ave
Visalia, CA 93291
Phone (559) 737-4792
Interoperability endpoints
- dwetmore1648055@oc.providencedirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA22901 | CA | Yes |
Addresses
Primary practice location
121 Sotoyome St Ste 201
Santa Rosa, CA 95405
Mailing address
PO Box 5510
Napa, CA 94581-0510
Phone (707) 252-9660
Other practice location 1
501 Lighthouse Ave
Monterey, CA 93940-1439
Phone (831) 649-0770
Other practice location 2
501 Lighthouse Ave
Monterey, CA 93940-1439
Phone (831) 649-0770
Other practice location 3
1165 Montgomery Dr
Santa Rosa, CA 95405-4801
Phone (707) 303-1709
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA22901 | Other | CA | PHYSICIAN ASSISTANT |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dwetmore1648055@oc.providencedirect.org |
Other providers in Santa Rosa, CA
- John Andrew Westhafer
- Norman Paul Westhoff
- Dale Raymond Westrom
- Judy Marie Wetch
- Angela Merrisa Wetmore
- Nicole Wettach-Farias
- WHBC Midwives, Inc., a Nursing Corporation
- Catherine Ann Wheaton
- Wheelcare Express Inc.
- Wheelchair Transportation & Homecare Services LLC
All providers in Santa Rosa, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.