NPIMap

Individual provider Active NPI

Trieneke Ann Kylstra, MD

  • Family Medicine Physician
  • Ukiah, CA
National Provider Identifier
1740243286
Registry record updated Nov 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
AO65110 Issued in CA
Practice address
260 Hospital Dr
Suite 209
Ukiah, CA 95482-4533
Phone
(707) 463-8000
Fax
(707) 462-1111
NPI assigned
Apr 7, 2006
Last updated
Nov 5, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X AO65110 CA Primary

Addresses

Primary practice location

260 Hospital Dr
Suite 209
Ukiah, CA 95482-4533

Mailing address

260 Hospital Dr
Suite 207
Ukiah, CA 95482-4533
Phone (707) 463-8000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tkylstra1657939@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
I20060123001041 CA Practitioner - Family Practice 2668496118 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Cincinnati College of Medicine, 1996
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)

2323 Bethards Dr
Santa Rosa, CA 95405-8500
Phone (707) 542-1611

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions16
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AO65110CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Apr 1, 2013 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation Family Medicine CurrentSince Apr 1, 2013 Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Providence Health System - Southern California Past Accepting new patients
Ukiah Adventist Hospital Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Torrance Memorial Medical Center Past Accepting new patients
Providence Medical Foundation Family Medicine Past Accepting new patients

Locations

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

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

2323 Bethards Dr
Santa Rosa, CA 95405
Phone (707) 542-1611

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

6800 Palm Ave
Ste H
Sebastopol, CA 95472
Phone (707) 503-6100

Interoperability endpoints

  • Direct secure messaging: tkylstra1657939@oc.providencedirect.org

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1144368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1740243286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 HOSPITAL DR",
            "address_2": "SUITE 207",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824533",
            "telephone_number": "707-463-8000",
            "fax_number": "707-462-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 HOSPITAL DR",
            "address_2": "SUITE 209",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824533",
            "telephone_number": "707-463-8000",
            "fax_number": "707-462-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KYLSTRA",
        "first_name": "TRIENEKE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-07",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "AO65110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tkylstra1657939@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "2323 Bethards Dr",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954058500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ukiah, CA

Sources for this page

Verify at the official NPI Registry.