NPIMap

Organization Active NPI

Santa Rosa Gastroenterology Medical Associates

  • Gastroenterology Physician
  • Santa Rosa, CA
National Provider Identifier
1972683654
Registry record updated Oct 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
SANTA ROSA GASTROENTEROLOGY MEDICAL ASSOCIATES
Practice address
1210 Sonoma Ave
Suite B
Santa Rosa, CA 95405
Phone
(707) 544-5093
Fax
(707) 528-8444
NPI assigned
Oct 16, 2006
Last updated
Oct 1, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2008

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

Authorized official

Name
Robert Logan Faust, MDNPI 1891766861
Title
MD Director
Phone
(707) 544-5093

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X Primary

Addresses

Primary practice location

1210 Sonoma Ave
Suite B
Santa Rosa, CA 95405

Mailing address

1210 Sonoma Ave
Suite B
Santa Rosa, CA 95405
Phone (707) 544-5093

Other identifiers 1

IdentifierTypeStateIssuer
GR0101070MedicaidCA

Other names 1

  • SRGMA Inc Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222819200000",
    "number": "1972683654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 SONOMA AVE",
            "address_2": "SUITE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95405",
            "telephone_number": "707-544-5093",
            "fax_number": "707-528-8444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 SONOMA AVE",
            "address_2": "SUITE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95405",
            "telephone_number": "707-544-5093",
            "fax_number": "707-528-8444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA ROSA GASTROENTEROLOGY MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2008-10-01",
        "status": "A",
        "authorized_official_last_name": "FAUST",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LOGAN",
        "authorized_official_title_or_position": "MD DIRECTOR",
        "authorized_official_telephone_number": "707-544-5093",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0101070",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SRGMA Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.