Mitzi Carolina Fogg, RN, MSN, FNP in Rohnert Park, CA

Mitzi Carolina Fogg, RN, MSN, FNP is a medicare enrolled "Nurse Practitioner - Family" in Rohnert Park, California. Her current practice location is 1801 E Cotati Ave, Rohnert Park, California. You can reach out to her office (for appointments etc.) via phone at (707) 664-2921.

Mitzi Carolina Fogg is licensed to practice in California (license number 633049) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1881802148.

Contact Information

	Mitzi Carolina Fogg, RN, MSN, FNP
	1801 E Cotati Ave, Rohnert Park, CA 94928-3609
	(707) 664-2921
	(707) 664-2925

Map and Direction

Provider's Profile

Full Name	Mitzi Carolina Fogg
Gender	Female
Speciality	Nurse Practitioner - Family
Location	1801 E Cotati Ave, Rohnert Park, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1881802148
Provider Enumeration Date: 05/18/2007
Last Update Date: 10/25/2022

Medicare PECOS Information:

PECOS PAC ID: 0042483695
Enrollment ID: I20111027000338

Medical Identifiers

Medical identifiers for Mitzi Carolina Fogg such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1881802148	NPI	-	NPPES
1881802148	Medicaid	CA

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	633049 (California)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mitzi Carolina Fogg allows following entities to bill medicare on her behalf.

Entity Name	Permanente Medical Group Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mitzi Carolina Fogg is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mitzi Carolina Fogg, RN, MSN, FNP 3538 Skillman Ln, Petaluma, CA 94952-1208 Ph: (415) 827-0767	Mitzi Carolina Fogg, RN, MSN, FNP 1801 E Cotati Ave, Rohnert Park, CA 94928-3609 Ph: (707) 664-2921

Reviews and Comments

Nurse Practitioner Nurses in Rohnert Park, CA

Christine Gibson, C.N.M. Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1370 Medical Center Dr, Suite E, Rohnert Park, CA 94928 Phone: 707-584-3528 Fax: 707-584-3924
Holly Mcclure, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 5789 State Farm Dr Ste 110, Rohnert Park, CA 94928 Phone: 707-615-3347
Ms. Cynthia Sue Renfrew, RN,MS,FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1801 E Cotati Ave, Sonoma State University Student Health Center, Rohnert Park, CA 94928 Phone: 707-664-2921
Ms. Anne Marie Purdy, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 5821 Kristina Pl, Rohnert Park, CA 94928 Phone: 813-390-0162 Fax: 813-269-4669
Poonlarp Lurslurchachai, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1509 Keats Pl, Rohnert Park, CA 94928 Phone: 650-878-7525
Sandra Lynn Jay, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1450 Medical Center Drive, Suite 3, Rohnert Park, CA 94928 Phone: 707-547-4684 Fax: 707-585-7925
Lala Anderson, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 959 Golf Course Dr # 151, Rohnert Park, CA 94928 Phone: 707-952-5267

Mitzi Carolina Fogg, RN, MSN, FNP - Medicare Nurse Practitioner in Rohnert Park, CA