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AGEWELL PACE
NPI 1437833597
General Practice in Rohnert Park, CA

Active since June 09, 2023
5789 STATE FARM DR STE 110, ROHNERT PARK, CA 94928(707) 615-4437(707) 615-6955 Get Directions Write a Review

NPPES record last updated: June 9, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Agewell Pace NPPES

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

AGEWELL PACE (NPI 1437833597) is a healthcare organization registered as a general practice in Rohnert Park, California and active in the NPI registry since June 2023. The organization lists Derrick Whitacre, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1437833597
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameAGEWELL PACE
Location Address5789 STATE FARM DR STE 110Rohnert Park, CA 94928-6308
Mailing Address5789 State Farm Dr Ste 110Rohnert Park, CA 94928-6308 · (707) 615-4437 · Fax (707) 615-6955
Phone(707) 615-4437
Fax(707) 615-6955
Organization SubpartNo
Authorized OfficialDerrick WhitacreExecutive Director · (707) 615-4437
Enumeration DateJune 9, 2023
NPPES CertifiedJune 9, 2023
✔ NPI 1437833597 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedRegistered NurseTaxonomy 163W00000X
Also ListedClinic/CenterTaxonomy 261Q00000X
5789 STATE FARM DR STE 110, Rohnert Park, CA 94928
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

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

HOLLY MCCLURE NP
Nurse Practitioner (Gerontology)
5789 STATE FARM DR STE 110
ROHNERT PARK, CA 94928
Sonoma County (707) 615-3347
MRS. KONSTANZE EMMALINE CONRADT-FRANCO NP
Nurse Practitioner (Primary Care)
5789 STATE FARM DR STE 110
ROHNERT PARK, CA 94928
Sonoma County (707) 615-4437

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 Agewell Pace's NPI number?

The NPI number for Agewell Pace is 1437833597. It was assigned to this organization in the NPPES registry on June 9, 2023.

Where is Agewell Pace located?

Agewell Pace is located at 5789 State Farm Dr Ste 110, Rohnert Park, CA 94928. The listed phone number is (707) 615-4437.

What is Agewell Pace's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

When was this NPI record last updated?

The NPPES record for Agewell Pace was last updated on June 9, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.