DR. CHARLES WILLIAM PENGRA PH.D.
NPI 1093738619
Psychologist in Santa Rosa, CA

Active since July 25, 2006Opted out of Medicare · through Jan 1, 2028
722 SPRING ST, STE. 1, SANTA ROSA, CA 95404(707) 583-2360(707) 544-0825 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Charles William Pengra Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. CHARLES WILLIAM PENGRA PH.D. (NPI 1093738619) is an individual psychologist in Santa Rosa, California, licensed in California (PSY 6754) and active in the NPI registry since July 2006. He has opted out of Medicare through January 1, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1093738619
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameDR. CHARLES WILLIAM PENGRACredential: PH.D.
Location Address722 SPRING ST, STE. 1Santa Rosa, CA 95404-3902
Mailing Address722 Spring St, Ste. 1Santa Rosa, CA 95404-3902 · (707) 583-2360 · Fax (707) 544-0825
Fax(707) 544-0825
Sole ProprietorYes
Enumeration DateJuly 25, 2006
Last NPPES UpdateJuly 8, 2007
NPI 1093738619 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in CA · PSY 6754
Definition

A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

722 SPRING ST, Santa Rosa, CA 95404

Other Identifiers 1

Medicare ID-Type Unspecified00PL67540

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Dr. Charles William Pengra Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2016 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2016
Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Marriage & Family Therapist
722 SPRING ST
SANTA ROSA, CA 95404
Marriage & Family Therapist
722 SPRING ST
SANTA ROSA, CA 95404
Marriage & Family Therapist
722 SPRING ST
SANTA ROSA, CA 95404

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Charles Pengra's NPI number?

The NPI number for Charles Pengra is 1093738619. It was assigned to this individual provider in the NPPES registry on July 25, 2006.

Where is Charles Pengra located?

Charles Pengra practices at 722 Spring St Ste. 1, Santa Rosa, CA 95404. The listed phone number is (707) 583-2360.

What is Charles Pengra's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Charles Pengra enrolled in Medicare?

No. Charles Pengra has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Charles Pengra was last updated on July 8, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.