Individual provider Active NPI

Jill Erin Rothberg, M.D.

  • Psychiatry Physician
  • Santa Rosa, CA
National Provider Identifier
1811044407
Registry record updated Aug 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A069666 Issued in CA
Practice address
3333 Chanate Rd
Santa Rosa, CA 95404-1707
Phone
(707) 565-4919
NPI assigned
Jan 4, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A069666 CA Primary

Addresses

Primary practice location

3333 Chanate Rd
Santa Rosa, CA 95404-1707

Mailing address

3333 Chanate Rd
Santa Rosa, CA 95404-1707

Other identifiers 1

IdentifierTypeStateIssuer
000004900MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140519000729 CA Practitioner - Psychiatry 5496978512 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Irvine California College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
County of SonomaGroup PAC ID 4688658651, 28 clinicians

Practice addresses (Care Compare)

2225 Challenger Way
Santa Rosa, CA 95407-5441
Phone (707) 565-4861

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A069666CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Sonoma CurrentSince Jul 7, 2007 Accepting new patients
County of Sonoma CurrentSince Jul 7, 2007 Accepting new patients
County of Sonoma Current Accepting new patients

Locations

1450 Neotomas Ave
Ste 200
Santa Rosa, CA 95405
Phone (707) 565-4131

2225 Challenger Way
Santa Rosa, CA 95407
Phone (707) 565-4101

3333 Chanate Rd
Santa Rosa, CA 95404
Phone (707) 565-4900

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408320000000",
    "number": "1811044407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 CHANATE RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954041707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 CHANATE RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954041707",
            "telephone_number": "707-565-4919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTHBERG",
        "first_name": "JILL",
        "middle_name": "ERIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2014-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A069666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000004900",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.