Mitzi Carolina Fogg, R.N., M.S.N., F.N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

633049 Issued in CA

Practice address

1801 E Cotati Ave
Rohnert Park, CA 94928-3609

Phone

(707) 664-2921

Fax

(707) 664-2925

NPI assigned

May 18, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Redwood City, CA
  • NPI 1639252604
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Student Health Ctr Pharmacy

  • Student Health Clinic/Center
  • Rohnert Park, CA
  • NPI 1699838763
  NPD (past)

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1881802148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3538 SKILLMAN LN",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949521208",
            "telephone_number": "415-827-0767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 E COTATI AVE",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949283609",
            "telephone_number": "707-664-2921",
            "fax_number": "707-664-2925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOGG",
        "first_name": "MITZI",
        "middle_name": "CAROLINA",
        "credential": "R.N., M.S.N., F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-18",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "633049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881802148",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3900 Lakeville Hwy",
            "city": "Petaluma",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949545698",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christina Renee Fifer, R.D.
• Peggy Joan Filice, D.C.
• Firstsight Vision Services, Inc.
• Thomas M Fitzgerald, DPM
• James Fitzgibbon
• Barbaradee Foote
• Zoe Foster, LMP
• Fostering Early Learning Institute
• Kari R Foulke, M.D.
• Fox & Cub Family Wellness

• Family Nurse Practitioner in Rohnert Park, CA
• Providers in Rohnert Park, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.