Individual provider Active NPI

Konstanze Emmaline Conradt-Franco, NP

  • Primary Care Nurse Practitioner
  • Rohnert Park, CA
National Provider Identifier
1972308724
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
95031220 Issued in CA
Practice address
5789 State Farm Dr Ste 110
Rohnert Park, CA 94928-6308
Phone
(707) 615-4437
NPI assigned
Feb 17, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 95031220 CA Primary

Addresses

Primary practice location

5789 State Farm Dr Ste 110
Rohnert Park, CA 94928-6308

Mailing address

513 Webster St
Petaluma, CA 94952-2455
Phone (707) 495-2079

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
I20260323003516 CA Practitioner - Nurse Practitioner 9234613720 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, shared by 2 NPIs, 1,461 clinicians

Practice addresses (Care Compare)

905 E Washington St
Petaluma, CA 94952-3389
Phone (707) 763-9891

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95031220CAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Agewell Pace CurrentSince Feb 23, 2025 Accepting new patients

Locations

5789 State Farm Dr
Ste 110
Rohnert Park, CA 94928
Phone (707) 615-3347

Organizations & group practices 2

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": "1739750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739750400000",
    "number": "1972308724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "513 WEBSTER ST",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949522455",
            "telephone_number": "707-495-2079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5789 STATE FARM DR STE 110",
            "city": "ROHNERT PARK",
            "state": "CA",
            "postal_code": "949286308",
            "telephone_number": "707-615-4437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONRADT-FRANCO",
        "first_name": "KONSTANZE",
        "middle_name": "EMMALINE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-17",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "95031220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rohnert Park, CA

Sources for this page

Verify at the official NPI Registry.