Individual provider Active NPI

Adrienne Patrice Kassis, M.D.

  • Family Medicine Physician
  • Petaluma, CA
National Provider Identifier
1942338769
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A99717 Issued in CA
Practice address
1179 N McDowell Blvd
Petaluma, CA 94954-6559
Phone
(707) 559-7500
NPI assigned
Mar 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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 A99717 CA Primary

Addresses

Primary practice location

1179 N McDowell Blvd
Petaluma, CA 94954-6559

Mailing address

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

Other practice location 1

1004 Northgate Dr
San Rafael, CA 94903-2502
Phone (415) 590-6150

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
I20250108003635 CA Order and Referring Only - Family PracticePractitioner - Family Practice 7113013442

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Tufts University School of Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Petaluma Health Center IncGroup PAC ID 9133180375, shared by 8 NPIs, 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

PO Box
Point Reyes Station, CA 94956-0910

Hospital & facility affiliations

  • Petaluma Valley Hospital Hospital, Petaluma, CA, CCN 050136
  • Providence Santa Rosa Memorial Hospital Hospital, Santa Rosa, CA, CCN 050174

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A99717CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marin General Hospital Past Accepting new patients
University of California San Francisco Past Accepting new patients
Petaluma Health Center Inc Past Accepting new patients
SRM Alliance Hospital Services Past Accepting new patients
UCSF Health Community Hospitals Past Accepting new patients
Petaluma Health Center Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: akassis613920@direct.ochin.org

Organizations & group practices 6

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.

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": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1942338769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1179 N MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546559",
            "telephone_number": "707-559-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1179 N MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546559",
            "telephone_number": "707-559-7500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1004 Northgate Dr",
            "address_purpose": "LOCATION",
            "city": "San Rafael",
            "state": "CA",
            "postal_code": "949032502",
            "country_code": "US",
            "telephone_number": "415-590-6150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KASSIS",
        "first_name": "ADRIENNE",
        "middle_name": "PATRICE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-01",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A99717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petaluma, CA

Sources for this page

Verify at the official NPI Registry.