JORDAN ROSE
NPI 1164095964
Nurse Practitioner - Psychiatric/Mental Health in Santa Rosa, CA
About Jordan Rose NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JORDAN ROSE (NPI 1164095964) is an individual psychiatric/mental health provider in Santa Rosa, California, licensed in California (95025794) and active in the NPI registry since July 2021. He is enrolled in Medicare PECOS and is a graduate of Other (2023).
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jordan Rose is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Jordan Rose reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Santa Rosa, CA 95403
- Reassigned Medicare billing, California enrollment
- 22 clinicians in this Medicare group
Las Vegas, NV 89119
- Reassigned Medicare billing, California enrollment
- 8 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 95401 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
SANTA ROSA, CA 95401
SANTA ROSA, CA 95401
SANTA ROSA, CA 95401
SANTA ROSA, CA 95401
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 Jordan Rose's NPI number?
The NPI number for Jordan Rose is 1164095964. It was assigned to this individual provider in the NPPES registry on July 20, 2021.
Where is Jordan Rose located?
Jordan Rose practices at 1287 Fulton Rd, Santa Rosa, CA 95401. The listed phone number is (707) 800-7700.
What is Jordan Rose's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Jordan Rose enrolled in Medicare?
Yes. Jordan Rose is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Jordan Rose's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jordan Rose reassigns Medicare benefits to 2 organizations: Torrico Medical Group Inc (Santa Rosa, CA) and Deepa Hasija MD (Las Vegas, NV). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jordan Rose's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Jordan Rose was last updated on June 26, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Jordan Rose · NPI 1164095964
Psychiatric/Mental Health physician in Santa Rosa, California. Individual provider, active in the CMS NPPES registry since July 20, 2021.
## Identity
- **NPI:** 1164095964 (Entity type: Individual)
- **Enumerated:** July 20, 2021
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** 95025794 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 1287 FULTON RD, Santa Rosa, CA 95401-4923
- **Phone:** (707) 800-7700
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Torrico Medical Group Inc (NPI 1033926480, Santa Rosa, CA); Deepa Hasija MD (NPI 1841721917, Las Vegas, NV) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2023
## Record status
- **NPPES last updated:** June 26, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1164095964) · Data from the CMS NPPES public registry.