Kyle Grgich (NPI# 1972018745, PAC ID# 3678838760) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1972018745 |
| PAC ID by PECOS | 3678838760 |
| Professional Enrollment ID | I20180518001918 |
| Full Name | Kyle Grgich |
| Organization Legal Name | ST JOSEPH HERITAGE HEALTHCARE |
| Address |
525 Doyle Park Dr Suite 102 Santa Rosa CA 95405-4562 |
| Phone Number | 7073873906 |
| Gender | M |
| Graduation Year | 2017 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 8921993205 |
| Number of Group Practice Members | 1049 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 050174 | SANTA ROSA MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 1165 Montgomery Dr, Santa Rosa, CA 95405-4801 | 7075463210 | ST JOSEPH HERITAGE HEALTHCARE |
| 525 Doyle Park Dr, Suite 102, Santa Rosa, CA 95405-4562 | 7073873906 | ST JOSEPH HERITAGE HEALTHCARE |
| Organization Legal Name | ST JOSEPH HERITAGE HEALTHCARE |
| Physicians | 1022 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Tarah N Nelson | Nurse Practitioner | St Joseph Heritage Healthcare | 2460 Buhne St, Eureka, CA 95501-3207 |
| Kristen Shay Rasnick | Nurse Practitioner | St Joseph Heritage Healthcare | 6580 Hembree Ln, Suite 270, Windsor, CA 95492-6885 |
| Basit Rahim | Neurology | St Joseph Heritage Healthcare | 26800 Crown Valley Pkwy, Suite 385, Mission Viejo, CA 92691-7320 |
| Elizabeth Wachtel O'brien | Certified Nurse Midwife (cnm) | St Joseph Heritage Healthcare | 3307 Renner Dr, Fortuna, CA 95540-3119 |
| Michael James Glamore | Urology | St Joseph Heritage Healthcare | 1701 4th St, Suite 200, Santa Rosa, CA 95404-3661 |
| Teresa E Shields-szabo | Family Medicine | St Joseph Heritage Healthcare | 26795 Portola Pkwy, Foothill Ranch, CA 92610-1713 |
| Austin James Perkins | Physician Assistant | St Joseph Heritage Healthcare | 100 E Valencia Mesa Dr, Suite 105, Fullerton, CA 92835-3816 |
| Sherin Ann Chakkalakel | Nurse Practitioner | St Joseph Heritage Healthcare | 905 E Washington St, St Joseph Heritage Healthcare, Petaluma, CA 94952-3389 |
| Jamie Lea Meyer | Nurse Practitioner | St Joseph Heritage Healthcare | 2332 23rd St, Eureka, CA 95501-3231 |
| Laura Elizabeth Hall | Nurse Practitioner | St Joseph Heritage Healthcare | 2280 Harrison Ave, Suite K, Eureka, CA 95501-3200 |
| Street Address |
525 DOYLE PARK DR SUITE 102 |
| City | SANTA ROSA |
| State | CA |
| Zip | 95405-4562 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Giac Donati Consiglieri | Neurology | St Joseph Heritage Healthcare | 525 Doyle Park Dr, Suite 102, Santa Rosa, CA 95405-4562 |
| Jaremy L Kwock | Physician Assistant | St Joseph Heritage Healthcare | 525 Doyle Park Dr, Suite 102, Santa Rosa, CA 95405-4562 |
| Rasha Souheil Germain | Neurosurgery | St Joseph Heritage Healthcare | 525 Doyle Park Dr, Suite 102, Santa Rosa, CA 95405-4562 |
| Kurtis G Birch | Neurosurgery | St Joseph Heritage Healthcare | 525 Doyle Park Dr, Suite 102, Santa Rosa, CA 95405-4562 |
| Eric Schmidt | Orthopedic Surgery | 525 Doyle Park Dr, Suite 101, Santa Rosa, CA 95405-4516 | |
| Ronald J Botelho | Anesthesiology | 525 Doyle Park Dr, Suite 102, Santa Rosa, CA 95405-4562 | |
| Marc E Thorne | Physician Assistant | Eric S Schmidt, Md, Inc | 525 Doyle Park Dr, Santa Rosa, CA 95405-4516 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Larry Marianella | Internal Medicine | 1515 Montgomery Dr, Santa Rosa, CA 95405-4500 | |
| Jean Claude Bassila | Nephrology | 435 Doyle Park Dr, Santa Rosa, CA 95405-4515 | |
| Michael G Carlston | Family Medicine | 427 Doyle Park Dr, Santa Rosa, CA 95405-4515 | |
| Stephen Lee | Nephrology | Santa Rosa Kidney Care PC | 435 Doyle Park Dr, Santa Rosa, CA 95405-4515 |
| Tomas Vasiliauskas | Cardiovascular Disease (cardiology) | St Joseph Heritage Healthcare | 500 Doyle Park Dr, Santa Rosa, CA 95405-4555 |
| Priscilla T Ngo | Nurse Practitioner | St Joseph Heritage Healthcare | 500 Doyle Park Dr, Suite 303, Santa Rosa, CA 95405-4555 |
| Jaya R Mallidi | Cardiovascular Disease (cardiology) | St Joseph Heritage Healthcare | 500 Doyle Park Dr, Suite G05, Santa Rosa, CA 95405-4555 |
| Marlon C Decastro | Internal Medicine | St Joseph Heritage Healthcare | 500 Doyle Park Dr, Suite 303, Santa Rosa, CA 95405-4555 |
| Thomas Degenhardt | Orthopedic Surgery | Santa Rosa Orthopaedic Medical Group, Inc. | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 |
| Mark Schakel | Orthopedic Surgery | Santa Rosa Orthopaedic Medical Group, Inc. | 1405 Montgomery Dr, Santa Rosa, CA 95405-4557 |
| Find all physicians in zip 95405 | |||
| City | SANTA ROSA |
| Zip Code | 95405 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | SANTA ROSA + PHYSICIAN ASSISTANT |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.