NPIMap

Individual provider Active NPI

Thomas A. Bertolli, M.D.

  • Family Medicine Physician
  • Laytonville, CA
National Provider Identifier
1811089717
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A38824 Issued in CA
Practice address
50 Branscomb Road
Laytonville, CA 95454
Phone
(707) 984-6131
Fax
(707) 984-7337
NPI assigned
Sep 28, 2006
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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 A38824 CA Primary

Addresses

Primary practice location

50 Branscomb Road
Laytonville, CA 95454

Mailing address

PO Box 870
Laytonville, CA 95454-0870
Phone (707) 984-6131

Other practice location 1

46900 Ocean Dr
Gualala, CA 95445-8353
Phone (707) 884-4005

Other identifiers 1

IdentifierTypeStateIssuer
FHC03906FMedicaidCA

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
I20090911000627 CA Practitioner - Family Practice 4385799568 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
George Washington University School of Medicine, 1981
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

46900 Ocean View Way
Gualala, CA 95445-7548
Phone (707) 884-4005

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.98 of 100Reported as group
Quality
73.31
Promoting interoperability
92
Improvement activities
40
Cost
62

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
38824CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Redwood Coast Medical Services, Inc. CurrentSince Nov 12, 2009 Accepting new patients
Long Valley Health Center CurrentSince Mar 9, 2016 Accepting new patients
Mendocino Community Health Clinic, Inc. CurrentSince Oct 1, 2022 Accepting new patients
Redwood Coast Medical Services, Inc. CurrentSince Nov 12, 2009 Accepting new patients

Locations

5335 Lakeshore Blvd
Lakeport, CA 95453
Phone (707) 263-7725

50 Branscomb Rd
Laytonville, CA 95454
Phone (707) 984-6131

333 Laws Ave
Ukiah, CA 95482
Phone (707) 463-1113

45 Hazel St
Willits, CA 95490
Phone (707) 456-9600

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • FHIR API: https://fhir4.healow.com/fhir/r4/AECBBA
  • Direct secure messaging: thomas.bertolli.p1@direct.rcms-healthcare.nextgenshare.com

Organizations & group practices 5

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 3

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": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1811089717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 870",
            "city": "LAYTONVILLE",
            "state": "CA",
            "postal_code": "954540870",
            "telephone_number": "707-984-6131",
            "fax_number": "707-984-7337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 BRANSCOMB ROAD",
            "city": "LAYTONVILLE",
            "state": "CA",
            "postal_code": "95454",
            "telephone_number": "707-984-6131",
            "fax_number": "707-984-7337"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "46900 Ocean Dr",
            "address_purpose": "LOCATION",
            "city": "Gualala",
            "state": "CA",
            "postal_code": "954458353",
            "country_code": "US",
            "telephone_number": "707-884-4005",
            "fax_number": "707-884-9728",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERTOLLI",
        "first_name": "THOMAS",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A38824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC03906F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laytonville, CA

Sources for this page

Verify at the official NPI Registry.