NPIMap

Individual provider Active NPI

Michael Leonce Pezold, M.D.

  • Vascular Surgery Physician
  • Santa Rosa, CA
National Provider Identifier
1720377856
Registry record updated Aug 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
A168740 Issued in CA
Practice address
1162 Montgomery Dr Ste 300
Santa Rosa, CA 95405-4802
Phone
(707) 890-4250
Fax
(707) 476-2240
NPI assigned
Mar 29, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 276415 NY
Vascular Surgery Physician 2086S0129X A168740 CA Primary

Addresses

Primary practice location

1162 Montgomery Dr Ste 300
Santa Rosa, CA 95405-4802

Mailing address

1162 Montgomery Dr Ste 300
Santa Rosa, CA 95405-4802
Phone (707) 890-4250

Other practice location 1

550 1st Ave
New York, NY 10016-6402
Phone (212) 263-5506

Other practice location 2

525 E 68th St
Box 207
New York, NY 10065-4870
Phone (212) 746-5380

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mpezold1658156@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
I20200806002468 CA Practitioner - Vascular SurgeryPractitioner - General Surgery 3779908884 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
University of Colorado School of Medicine, Denver, 2011
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)

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

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion12
Coronary artery bypass graft (CABG)15
Varicose vein removal14
Leg revascularization (restoring blood flow)99
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
276415NYMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Aug 3, 2020 Accepting new patients
Providence Medical Foundation CurrentSince Aug 3, 2020 Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients
Ny Presbyterian Hospital - Cornell Past Accepting new patients
SRM Alliance Hospital Services Past Accepting new patients
Sutter Bay Medical Foundation Past Accepting new patients
Providence Medical Foundation Past Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

1162 Montgomery Dr
Ste 300
Santa Rosa, CA 95405
Phone (707) 890-4250

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

Interoperability endpoints

  • Direct secure messaging: mpezold558233@hisp.ehr.sutterhealth.org

Organizations & group practices 10

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 6

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": "1301356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756339200000",
    "number": "1720377856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1162 MONTGOMERY DR STE 300",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054802",
            "telephone_number": "707-890-4250",
            "fax_number": "707-476-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1162 MONTGOMERY DR STE 300",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054802",
            "telephone_number": "707-890-4250",
            "fax_number": "707-476-2240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "550 1st Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100166402",
            "country_code": "US",
            "telephone_number": "212-263-5506",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "525 E 68th St",
            "address_2": "Box 207",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100654870",
            "country_code": "US",
            "telephone_number": "212-746-5380",
            "fax_number": "212-746-8802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEZOLD",
        "first_name": "MICHAEL",
        "middle_name": "LEONCE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-29",
        "last_updated": "2025-08-28",
        "certification_date": "2025-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "276415",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "A168740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpezold1658156@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1162 Montgomery Dr Ste 3",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954054802",
            "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.