NPIMap

Organization Active NPI

Attenda Medical Group Inc

  • Family Medicine Physician
  • Santa Rosa, CA
National Provider Identifier
1740866615
Registry record updated Sep 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ATTENDA MEDICAL GROUP INC
Practice address
1701 4TH St Ste 100
Santa Rosa, CA 95404-3661
Phone
(707) 575-6033
NPI assigned
Mar 22, 2021
Last updated
Sep 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2021

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

Authorized official

Name
Roberta Lee, MD
Title
Ceo
Phone
(707) 275-6383

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromusculoskeletal Medicine & OMM Physician 204D00000X NU
Family Medicine Physician 207Q00000X NU Primary
Podiatrist 213E00000X NU

Addresses

Primary practice location

1701 4TH St Ste 100
Santa Rosa, CA 95404-3661

Mailing address

3510 Unocal PL Ste 207
Santa Rosa, CA 95403-0918
Phone (707) 275-6383

Other practice location 1

1116 B St
Petaluma, CA 94952-4054
Phone (707) 782-9123

Other practice location 2

45081 Little Lake St
Mendocino, CA 95460-9618
Phone (707) 937-1055

Other practice location 3

506 S Main St
Sebastopol, CA 95472-4261
Phone (707) 829-5455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210416000917 CA Part B Supplier - Clinic/Group Practice 6507274354 Receives reassigned benefits from 8 practitioners
Practice locations: Petaluma, CA; Sebastopol, CA; Santa Rosa, CA; Mendocino, CA
O20210628000448 CA DME Supplier - Multi-Specialty - Physician 6507274354 Practice locations: Santa Rosa, CA

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/Freedom_AMG

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1616371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632960000000",
    "number": "1740866615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3510 UNOCAL PL STE 207",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954030918",
            "telephone_number": "707-275-6383",
            "fax_number": "707-545-5408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 4TH ST STE 100",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954043661",
            "telephone_number": "707-575-6033"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1116 B St",
            "address_purpose": "LOCATION",
            "city": "Petaluma",
            "state": "CA",
            "postal_code": "949524054",
            "country_code": "US",
            "telephone_number": "707-782-9123",
            "fax_number": "707-782-9622",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "45081 Little Lake St",
            "address_purpose": "LOCATION",
            "city": "Mendocino",
            "state": "CA",
            "postal_code": "954609618",
            "country_code": "US",
            "telephone_number": "707-937-1055",
            "fax_number": "707-937-1061",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "506 S Main St",
            "address_purpose": "LOCATION",
            "city": "Sebastopol",
            "state": "CA",
            "postal_code": "954724261",
            "country_code": "US",
            "telephone_number": "707-829-5455",
            "fax_number": "707-824-9235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ATTENDA MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-22",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "ROBERTA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "707-275-6383",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.