| Vista Campus | |
|
3569 Round Barn Circle Santa Rosa CA 95403-5781 | |
| (707) 303-3600 | |
| (707) 303-3635 |
| Full Name | Vista Campus |
|---|---|
| Speciality | Clinic/Center |
| Location | 3569 Round Barn Circle, Santa Rosa, California |
| Authorized Official Name and Position | Gabriela Bernal-leroi (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7073033600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vista Campus 3569 Round Barn Circle Santa Rosa CA 95403-5781 Ph: (707) 303-3600 | Vista Campus 3569 Round Barn Circle Santa Rosa CA 95403-5781 Ph: (707) 303-3600 |
| NPI Number | 1578631172 |
|---|---|
| Provider Enumeration Date | 12/01/2006 |
| Last Update Date | 12/09/2022 |
| Medicare PECOS PAC ID | 0345130423 |
|---|---|
| Medicare Enrollment ID | O20040319001444 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578631172 | NPI | - | NPPES |
| FHC71099F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 550000087 (California) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 550000087 (California) | Primary |
| Provider Name | Anne Margaret French |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528141587 PECOS PAC ID: 2163314105 Enrollment ID: I20040325001405 |
| Provider Name | Barbara A Sinclair |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154430890 PECOS PAC ID: 5496700486 Enrollment ID: I20050311000912 |
| Provider Name | David Schneider |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104885672 PECOS PAC ID: 3577591643 Enrollment ID: I20050729000810 |
| Provider Name | Carla P Longchamp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972544948 PECOS PAC ID: 8729003942 Enrollment ID: I20051006000906 |
| Provider Name | Tabitha Doniach |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952344616 PECOS PAC ID: 2264459197 Enrollment ID: I20051028001011 |
| Provider Name | Tara D Scott |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528023835 PECOS PAC ID: 0345267290 Enrollment ID: I20051029000198 |
| Provider Name | Michael C Shulkin |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1790893824 PECOS PAC ID: 0042225674 Enrollment ID: I20060220000065 |
| Provider Name | Christine Martin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1871685370 PECOS PAC ID: 4284632779 Enrollment ID: I20061116000337 |
| Provider Name | Kevin M Li |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619186764 PECOS PAC ID: 9133284250 Enrollment ID: I20090224000350 |
| Provider Name | Laurence Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700050200 PECOS PAC ID: 5991861908 Enrollment ID: I20090226000555 |
| Provider Name | Joseph Matel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871792382 PECOS PAC ID: 9638236573 Enrollment ID: I20090320000499 |
| Provider Name | Fasih A Hameed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417083031 PECOS PAC ID: 5991850877 Enrollment ID: I20090827000784 |
| Provider Name | Joseph I Eichenseher |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164628590 PECOS PAC ID: 3577758473 Enrollment ID: I20101117000163 |
| Provider Name | Briant Smith |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1639253628 PECOS PAC ID: 2961682000 Enrollment ID: I20110208000114 |
| Provider Name | Anthony Frank Soria |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1346219755 PECOS PAC ID: 4183755507 Enrollment ID: I20120314000336 |
| Provider Name | Judith Hong |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1083949853 PECOS PAC ID: 4082878558 Enrollment ID: I20120613000221 |
| Provider Name | Christoph Gelsdorf |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063656908 PECOS PAC ID: 6709033806 Enrollment ID: I20120824000280 |
| Provider Name | Jennifer Fish |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619111556 PECOS PAC ID: 3779734108 Enrollment ID: I20121113000352 |
| Provider Name | James Wu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548404494 PECOS PAC ID: 4183869928 Enrollment ID: I20130326000481 |
| Provider Name | Ilka De Gast |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649576851 PECOS PAC ID: 7618192030 Enrollment ID: I20140627000211 |
| Provider Name | Kim D Shippey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497817670 PECOS PAC ID: 5395063937 Enrollment ID: I20150413000253 |
| Provider Name | Allison Danielle Bacon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720254584 PECOS PAC ID: 9032384557 Enrollment ID: I20150421001870 |
| Provider Name | Mia P Tiscareno |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316354350 PECOS PAC ID: 3870810328 Enrollment ID: I20160311001609 |
| Provider Name | Eileen Philbin Muldoon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073849162 PECOS PAC ID: 6305989385 Enrollment ID: I20160401000706 |
| Provider Name | Caitlin Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184904013 PECOS PAC ID: 6608041116 Enrollment ID: I20170105000498 |
| Provider Name | Douglas Jimenez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154474781 PECOS PAC ID: 7719879899 Enrollment ID: I20170727002656 |
| Provider Name | Jessica A Koenig |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083050967 PECOS PAC ID: 4486952017 Enrollment ID: I20171115002887 |
| Provider Name | Lingjin Meng |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730574575 PECOS PAC ID: 3476805037 Enrollment ID: I20181009002190 |
| Provider Name | Erin Elizabeth Bulleit |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639564974 PECOS PAC ID: 0244544948 Enrollment ID: I20201012002716 |
| Provider Name | Charys Hayden-town |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629697883 PECOS PAC ID: 2062822414 Enrollment ID: I20201113001361 |
| Provider Name | Navpreet Sidhu |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1043741184 PECOS PAC ID: 8426388794 Enrollment ID: I20201207001071 |
| Provider Name | Alecia Lanette Greenlee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487072922 PECOS PAC ID: 4688977325 Enrollment ID: I20210304002115 |
| Provider Name | Sarah B Sands |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407526676 PECOS PAC ID: 7719352178 Enrollment ID: I20230417002462 |
| Provider Name | Alexander Threlfall |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1669538187 PECOS PAC ID: 6103113857 Enrollment ID: I20230616000446 |
| Provider Name | Chloe S Minervini |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811562747 PECOS PAC ID: 2163882994 Enrollment ID: I20230712001804 |
| Provider Name | Marie Ann Mulligan |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1477682896 PECOS PAC ID: 6901055664 Enrollment ID: I20230727003834 |
| Provider Name | Elisa Glubok Gonzalez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346879095 PECOS PAC ID: 4284096025 Enrollment ID: I20230810004238 |
| Provider Name | Willis Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861882847 PECOS PAC ID: 3173934585 Enrollment ID: I20230818000484 |
| Provider Name | Jennifer Francis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770148108 PECOS PAC ID: 0749697662 Enrollment ID: I20230925002232 |
| Provider Name | Nicole P Fernandes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558997569 PECOS PAC ID: 4284088295 Enrollment ID: I20230925003412 |
| Provider Name | Frances Rosario Gonzalez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801440136 PECOS PAC ID: 9133574171 Enrollment ID: I20231011003969 |
| Provider Name | Jacklyn Cheng |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306259098 PECOS PAC ID: 2264652015 Enrollment ID: I20231018004042 |
| Provider Name | Jennifer Denise Mendoza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154057750 PECOS PAC ID: 3577919497 Enrollment ID: I20231030002192 |
| Provider Name | Renee Teresa Cooper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972131498 PECOS PAC ID: 7416304381 Enrollment ID: I20231114003669 |
| Provider Name | Kameren Joy Owens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942225156 PECOS PAC ID: 3971518150 Enrollment ID: I20231122001609 |
| Provider Name | Nicole Bayard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154954600 PECOS PAC ID: 8527418763 Enrollment ID: I20231229001200 |
| Provider Name | Veronica I Vega |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891977104 PECOS PAC ID: 1759732712 Enrollment ID: I20240104000796 |
| Provider Name | Alea Catherine Campos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801584966 PECOS PAC ID: 5991148918 Enrollment ID: I20240207000784 |
| Provider Name | Erin Marie Byrn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356125314 PECOS PAC ID: 2062855000 Enrollment ID: I20240207001297 |
| Provider Name | Melissa Anne Winkelhaus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609557149 PECOS PAC ID: 6406299452 Enrollment ID: I20240207001713 |
| Provider Name | Amanda Mae Vergel De Dios |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679069058 PECOS PAC ID: 0941646814 Enrollment ID: I20240313003867 |
| Provider Name | Sahab Danesh |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1538655279 PECOS PAC ID: 1759761927 Enrollment ID: I20240320004023 |
| Provider Name | Melissa De Asis Deocampo- Escalante |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972389948 PECOS PAC ID: 0749628550 Enrollment ID: I20240329000279 |
| Provider Name | Allison Jhin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1760010102 PECOS PAC ID: 0749658136 Enrollment ID: I20240329002075 |
| Provider Name | Stephanie Bamidele |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427518844 PECOS PAC ID: 1557709284 Enrollment ID: I20240401001888 |
| Provider Name | Mansi Shah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831552306 PECOS PAC ID: 6608169081 Enrollment ID: I20240402001002 |
| Provider Name | Stephanie Mayorga |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1083145544 PECOS PAC ID: 2062850399 Enrollment ID: I20240405001953 |
| Provider Name | Brandon Cortez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538521828 PECOS PAC ID: 1355770314 Enrollment ID: I20240410002275 |
| Provider Name | Ele Lozares-lewis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881860666 PECOS PAC ID: 5890946149 Enrollment ID: I20240415003020 |
| Provider Name | Casandra Camacho |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669879334 PECOS PAC ID: 6002146818 Enrollment ID: I20240415003590 |
| Provider Name | Kevin Skyler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760166144 PECOS PAC ID: 7810336419 Enrollment ID: I20240416001038 |
| Provider Name | Lisa Sara Polon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366879967 PECOS PAC ID: 6305285529 Enrollment ID: I20240419001876 |
| Provider Name | Jill Hutton Davidson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265211155 PECOS PAC ID: 3779923446 Enrollment ID: I20240429000575 |
| Provider Name | Anna Mccoy |
|---|---|
| Provider Type | Practitioner - Other (physician) |
| Provider Identifiers | NPI Number: 1841911419 PECOS PAC ID: 9638519374 Enrollment ID: I20240429003266 |
| Provider Name | Parker Andrew Duncan Diaz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033434923 PECOS PAC ID: 1850524422 Enrollment ID: I20240503001420 |
| Provider Name | Rebecca Anne Como |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225769524 PECOS PAC ID: 7719327857 Enrollment ID: I20240506004129 |
| Provider Name | Sibylle Maria Margaretha Koenig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285226092 PECOS PAC ID: 3173963253 Enrollment ID: I20240507000935 |
| Provider Name | Carolina Jimenez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598477358 PECOS PAC ID: 6800237363 Enrollment ID: I20240515000690 |
| Provider Name | Benjamin Robert Zumwalt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952932709 PECOS PAC ID: 7315350493 Enrollment ID: I20240521001965 |
| Provider Name | Kyle Edward Ransom |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013404318 PECOS PAC ID: 2961884416 Enrollment ID: I20240521003772 |
Sutter Medical Group Of The Redwoods Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4725a Hoen Ave, Santa Rosa, CA 95405 Phone: 707-576-3322 | |
Elyse R. Eisenberg, Md, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 725 Farmers Ln, Ste 10, Santa Rosa, CA 95405 Phone: 707-523-3375 Fax: 866-870-0815 | |
Sutter Medical Group Of The Redwoods Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4750 Hoen Ave, Santa Rosa, CA 95405 Phone: 707-523-2666 Fax: 707-523-3399 | |
St Joseph Heritage Healthcare Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4750 Hoen Ave, Santa Rosa, CA 95405 Phone: 707-542-1611 Fax: 707-542-9958 | |
Thomas M. Collins Chiropractic, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1212 Farmers Ln, Suite 2, Santa Rosa, CA 95405 Phone: 707-566-7396 Fax: 707-566-7398 | |
Vanguard Performance Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2901 Cleveland Ave Ste 202, Santa Rosa, CA 95403 Phone: 707-968-1555 Fax: 844-426-0134 | |
Sonoma County Junior College District Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1501 Mendocino Ave, Santa Rosa, CA 95401 Phone: 707-527-4445 Fax: 707-524-1858 |