Individual provider Active NPI

Paula Pelavin, P.A.

  • Physician Assistant
  • Rohnert Park, CA
National Provider Identifier
1821458761
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
5900 State Farm Dr Ste 200
Rohnert Park, CA 94928-2149
Phone
(707) 559-7500
NPI assigned
Mar 4, 2016
Last updated
Jul 10, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

5900 State Farm Dr Ste 200
Rohnert Park, CA 94928-2149

Mailing address

5900 State Farm Dr Ste 200
Rohnert Park, CA 94928-2149

Other practice location 1

1179 N McDowell Blvd
Petaluma, CA 94954-6559
Phone (707) 559-7500

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160811001651 CA Practitioner - Physician Assistant 1658665781 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Tufts University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Petaluma Health Center IncGroup PAC ID 9133180375, 76 clinicians
Coastal Health AllianceGroup PAC ID 7315919933, 40 clinicians

Practice addresses (Care Compare)

1179 N McDowell Blvd
Petaluma, CA 94954-6559
Phone (707) 559-7500

5900 State Farm Dr
Suite 200
Rohnert Park, CA 94928-2149
Phone (707) 559-7600

PO Box
Suite 910
Point Reyes Station, CA 94956-0910

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
53347CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Petaluma Health Center, Inc CurrentSince Aug 4, 2022 Accepting new patients
Petaluma Health Center Inc CurrentSince Aug 4, 2022 Accepting new patients
Petaluma Health Center Inc Past Accepting new patients

Locations

1179 N McDowell Blvd
Petaluma, CA 94954

5900 State Farm Dr
Ste 200
Rohnert Park, CA 94928
Phone (707) 559-7600

Interoperability endpoints

  • Direct secure messaging: ppelavin614159@direct.ochin.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1457049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1821458761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 STATE FARM DR STE 200",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949282149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 STATE FARM DR STE 200",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949282149",
            "telephone_number": "707-559-7500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1179 N McDowell Blvd",
            "address_purpose": "LOCATION",
            "city": "Petaluma",
            "state": "CA",
            "postal_code": "949546559",
            "country_code": "US",
            "telephone_number": "707-559-7500",
            "fax_number": "707-559-7620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PELAVIN",
        "first_name": "PAULA",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-04",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rohnert Park, CA

Sources for this page

Verify at the official NPI Registry.