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DR. SHANNON MENTOCK MD
NPI 1104353796
Family Medicine in Petaluma, CA

Active since May 15, 2017PECOS EnrolledAccepts Medicare Assignment
1179 N MCDOWELL BLVD, PETALUMA, CA 94954(707) 559-7500(707) 559-7620 Get Directions Write a Review

NPPES record last updated: March 21, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 29, 2021, Jul 17, 2020, May 15, 2017 (3 updates tracked since 2017).

About Dr. Shannon Mentock Md NPPES

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

DR. SHANNON MENTOCK MD (NPI 1104353796) is an individual family medicine provider in Petaluma, California, licensed in California (174978) and active in the NPI registry since May 2017. She is enrolled in Medicare PECOS and is a graduate of Wake Forest University School Of Medicine (2017).

NPPES Registry Identity

NPI1104353796
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameDR. SHANNON MENTOCKCredential: MD
Location Address1179 N MCDOWELL BLVDPetaluma, CA 94954-6559
Mailing Address1179 N Mcdowell BlvdPetaluma, CA 94954-6559 · (707) 559-7500
Phone(707) 559-7500
Fax(707) 559-7620
Sole ProprietorNo
Medical School CMSWake Forest University School Of MedicineGraduated 2017
Enumeration DateMay 15, 2017
Last NPPES UpdateMarch 21, 20223 updates tracked since enumeration
NPPES CertifiedMarch 21, 2022
✔ NPI 1104353796 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Licenses✔ Licensed in CA · 174978✔ Licensed in CO · DR.0063003
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
1179 N MCDOWELL BLVD, Petaluma, CA 94954
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Shannon Mentock Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8426327065
PECOS Enrollment IDI20200827000829
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 94954 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.16 typical visit price
range $63.04 – $187.01
Typical copayment $24.04 (range $15.76 – $46.75)
Most-billed visit code 99203
Established Patient
$109.88 typical visit price
range $21.02 – $153.40
Typical copayment $27.47 (range $5.25 – $38.35)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

REBECCA KATZ FINNEMORE MD
Family Medicine
1179 N MCDOWELL BLVD
PETALUMA, CA 94954
Sonoma County (707) 559-7500
ROXANA INFANTE
Physician Assistant
1179 N MCDOWELL BLVD
PETALUMA, CA 94954
Sonoma County (707) 559-7500
HEIDI DITTRICH NP
Nurse Practitioner (Family)
1179 N MCDOWELL BLVD
PETALUMA, CA 94954
Sonoma County (707) 559-7500
VANESSA ISELA BERMUDEZ-VILLALPANDO
Family Medicine
1179 N MCDOWELL BLVD
PETALUMA, CA 94954
Sonoma County (707) 559-7500
DR. ANDREW BURNS ASHCROFT M.D.
Family Medicine
1179 N MCDOWELL BLVD
PETALUMA, CA 94954
Sonoma County (707) 559-7500
DR. SHRADHA BIRADAR DO
Family Medicine
1179 N MCDOWELL BLVD
PETALUMA, CA 94954
Sonoma County (707) 559-7500
JARED ANDREW INING DDS
Dentist
1179 N MCDOWELL BLVD
PETALUMA, CA 94954
Sonoma County (707) 559-7500
LORENA YANEZ-RAMIREZ ACSW
Social Worker (Clinical)
1179 N MCDOWELL BLVD
PETALUMA, CA 94954
Sonoma County (707) 559-7500

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 Shannon Mentock's NPI number?

The NPI number for Shannon Mentock is 1104353796. It was assigned to this individual provider in the NPPES registry on May 15, 2017.

Where is Shannon Mentock located?

Shannon Mentock practices at 1179 N Mcdowell Blvd, Petaluma, CA 94954. The listed phone number is (707) 559-7500.

What is Shannon Mentock's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Shannon Mentock enrolled in Medicare?

Yes. Shannon Mentock is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Shannon Mentock was last updated on March 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.