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MS. EMILY G PENGELLY PA-C, MD
NPI 1699072470
Student in an Organized Health Care Education/Training Program in Santa Rosa, CA

Active since February 14, 2011PECOS Enrolled
401 BICENTENNIAL WAY, SANTA ROSA, CA 95403(707) 495-3732 Get Directions Write a Review

NPPES record last updated: March 17, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Ms. Emily G Pengelly Pa-c, Md NPPES

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

MS. EMILY G PENGELLY PA-C, MD (NPI 1699072470) is an individual student in an organized health care education/training program in Santa Rosa, California and active in the NPI registry since February 2011. She is enrolled in Medicare PECOS and maintains a secondary practice location in White River Junction.

NPPES Registry Identity

NPI1699072470
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameMS. EMILY G PENGELLYCredential: PA-C, MD
Location Address401 BICENTENNIAL WAYSanta Rosa, CA 95403-2149
Mailing Address746 Pattrell RdNorwich, VT 05055-9479 · (210) 723-1843
Phone(707) 495-3732
Sole ProprietorNo
Enumeration DateFebruary 14, 2011
Last NPPES UpdateMarch 17, 2024
NPPES CertifiedMarch 17, 2024
✔ NPI 1699072470 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
Also ListedPhysician AssistantTaxonomy 363A00000X
401 BICENTENNIAL WAY, Santa Rosa, CA 95403
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Secondary Practice Location 1

Location 1331 Olcott Dr Ste U3White River Junction, VT 05001-9263 · Phone (802) 295-6132

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Emily G Pengelly Pa-c, Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
30 services25 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
13 services12 patients

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.

MS. JESSICA ANNE RUTLAND R.D.
Dietitian, Registered
401 BICENTENNIAL WAY
SANTA ROSA, CA 95403
Sonoma County (707) 393-4787
KURT FALKENBERG P.T.
Physical Therapist
401 BICENTENNIAL WAY, EAST BUILDING, SUITE 190
SANTA ROSA, CA 95403
Sonoma County (707) 571-3352
DELILAH PATTERSON CRNA
Nurse Anesthetist, Certified Registered
401 BICENTENNIAL WAY
SANTA ROSA, CA 95403
Sonoma County (707) 393-4616
KRISZTINA J. BALAZS MD
Pediatrics
401 BICENTENNIAL WAY
SANTA ROSA, CA 95403
Sonoma County (707) 571-4000
JOHN F. KUNKEL MD
Pathology (Anatomic Pathology)
401 BICENTENNIAL WAY
SANTA ROSA, CA 95403
Sonoma County (707) 571-4000
CRISTINA COREY SCHROEN LCSW
Social Worker (Clinical)
401 BICENTENNIAL WAY
SANTA ROSA, CA 95403
Sonoma County (707) 571-2536
JIE GIOK RAHARDJA PHARMD
Pharmacist
401 BICENTENNIAL WAY
SANTA ROSA, CA 95403
Sonoma County (707) 393-4652
CONOR WILLIAM BOWMAN PHARM.D.
Pharmacist
401 BICENTENNIAL WAY
SANTA ROSA, CA 95403
Sonoma County (818) 522-1238

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 Emily Pengelly's NPI number?

The NPI number for Emily Pengelly is 1699072470. It was assigned to this individual provider in the NPPES registry on February 14, 2011.

Where is Emily Pengelly located?

Emily Pengelly practices at 401 Bicentennial Way, Santa Rosa, CA 95403. The listed phone number is (707) 495-3732.

What is Emily Pengelly's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Emily Pengelly enrolled in Medicare?

Yes. Emily Pengelly is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Emily Pengelly was last updated on March 17, 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.