September 7, 2026
Healthcare built around your time, your goals, and your life
Why I built this practice, what direct primary care actually means, and what changes when a visit is measured in an hour instead of ten minutes.
Now enrolling founding members
Expert care, in the comfort of home
Direct primary care for busy adults and unhurried house calls for seniors — from one nurse practitioner who actually knows you. No waiting rooms, no 15-minute appointments, no phone tree.
Charter Member Circle: founding pricing for the first 20 members — see the offer
Rebecca “Becky” Spear, DNP · Caring for adults 30–65+ across the Sonoma Valley
“The best care happens where life happens. When I sit with someone at their own kitchen table, I see the whole picture — and I have the time to actually listen.”
— Becky Spear, DNP
Two ways we care for the valley
Whichever stage of life you’re in
The same unhurried, relationship-first medicine — delivered two different ways, depending on what your life looks like right now.
Adults 30–64
Direct primary care for busy adults
For working parents, professionals, and anyone who has put off calling a doctor because the wait for an appointment is longer than the time they have.
- Text or message Becky directly — she answers, not a call center
- Same-day or next-day telehealth for sinus infections, rashes, UTIs, minor injuries
- An annual health audit that goes deeper than “everything looks normal”
- Visits at your home or office, on your schedule
- Especially valuable with a high-deductible plan — and HSA-eligible in 2026
Adults 65+
Senior concierge & house calls
For older adults who want a clinician who comes to them, takes the time, and keeps the whole family in the loop.
- Unhurried 45–60 minute visits at your kitchen table
- Clinical care billed to Medicare Part B
- Deep medication review to cut unnecessary pills and fall risk
- Home safety, memory, and mobility assessed where you actually live
- Continuous coordination with your specialists and your family
Simple by design
How house calls work
1
Reach out
Book online or send a visit request in about two minutes, call (707) 939-5345, or email becky@sonomavalleynp.com. We’ll follow up with a free phone conversation to make sure we’re the right fit for you or your loved one.
2
We come to you
Your first visit happens at home and is never rushed. We review health history, medications, mobility, and what matters most to you.
3
Ongoing partnership
Regular follow-up visits, clear communication with family, and coordination with your other providers — so nothing falls through the cracks.
A different kind of practice
Why people choose care this way
Time to listen
Visits typically last 60–90 minutes — several times longer than a standard office appointment.
Care in context
Seeing the home reveals what an exam room can’t: fall risks, medication routines, nutrition, and daily life.
Expertise that spans decades
Twenty years in geriatrics means Becky knows exactly how today’s habits become tomorrow’s health — whether you’re 38 or 88.
No middlemen
Simple, transparent membership pricing. Your care is guided by your needs and your goals — not by 15-minute time slots.
What we offer
Services brought to your door
Care for adults at every stage of life — from busy professionals and parents who need answers fast, to older adults who want to stay safely at home.
Acute & urgent care visits
Sinus infections, sore throats, UTIs, rashes, minor injuries, and other sudden illnesses — handled same-day or next-day by telehealth or an in-person visit, without an urgent-care waiting room.
Same-day telehealth & direct messaging
Text or message your nurse practitioner directly for rapid advice, triage, and prescriptions — including after-hours guidance on whether something can safely wait.
Preventive & wellness care for adults
Annual health audits, metabolic and cardiovascular screening, lab review, and a practical plan to stay ahead of problems — for adults in their 30s, 40s, 50s, and 60s.
Comprehensive geriatric assessment
A whole-person review of health, function, memory, mood, and goals of care.
Chronic condition management
Ongoing support for diabetes, heart disease, COPD, hypertension, arthritis, and more.
Medication review & simplification
Careful review of every prescription to reduce side effects, interactions, and unnecessary pills.
Memory & cognitive concerns
Thoughtful evaluation of memory changes, with practical guidance for patients and families.
Fall prevention & home safety
In-home assessment of mobility and hazards, with a concrete plan to stay steady and independent.
After-hospital visits
Extra support during the fragile weeks after a hospital or rehab stay, when problems most often arise.
Care coordination & family support
Clear communication with specialists, caregivers, and family — everyone on the same page.
Advance care planning
Unhurried conversations about wishes and priorities, documented properly before a crisis.
Meet your clinician
Rebecca “Becky” Spear, DNP
DNP, ARNP, AGNP-C, GS-C · 20 years caring for older adults
I’ve spent 20 years caring for older adults, and I believe good medicine starts with a relationship — and relationships take time. Again and again I’ve seen the same thing: the people who most need thorough, thoughtful care are often the ones for whom getting to a clinic is hardest.
Sonoma Valley Nurse Practitioners Group is my answer. I bring the visit to you: a full appointment at your kitchen table or favorite armchair, with time to talk through every medication, every concern, and every goal. I work alongside your specialists and other providers, and I keep your family in the loop at every step.
I also care for younger adults — and that part is personal. I’m a working mom, and I know exactly what it’s like to put off calling about something because the wait for an appointment is longer than the time you have. You shouldn’t have to take a half-day off work, or sit in an urgent-care waiting room with a sick kid in your lap, to get a straight answer. My members text me and I answer — whether it’s a sinus infection that won’t quit, a lab result you don’t understand, or a question about what to do this weekend.
I earned my Master of Science in Nursing from Seattle University and my Doctor of Nursing Practice from the University of Arizona, where my award-winning research focused on preventing delirium in post-acute care. Over more than two decades of hospital-based and post-acute geriatric care, I’ve led senior-care initiatives — including work that helped earn Age-Friendly Health System recognition. I’m board-certified in adult-gerontology primary care (AGNP-C), hold the Gerontological Specialist certification (GS-C), and am an active member of the American Association of Nurse Practitioners (AANP), the Gerontological Advanced Practice Nurses Association (GAPNA), and the American Delirium Society.
Aging well doesn’t mean giving things up — it means having the right support to keep living the life you love, in the place you love. It would be a privilege to be part of that support for you.
In their words
What families are saying
We are so grateful for the exceptional care and compassion Becky has provided. She takes the time to truly listen, explains everything clearly, and makes us feel valued and supported. Her genuine concern has made a difficult journey so much easier. We highly recommend her.
— Emilie C.
Having a dedicated, board-certified advanced practice nurse come directly to my parent’s home has been an absolute game-changer. The visits are never rushed, the communication is seamless, and the level of expertise in senior care has given our entire family complete peace of mind. Exceptional, highly personalized medicine.
— A patient’s family
Simple & transparent
Direct Primary Care & Membership Options
At Sonoma Valley Nurse Practitioners Group, we offer transparent, relationship-centered healthcare without the constraints of insurance middlemen. Choose the membership or care tier that fits your stage of life.
Founding offer · first 20 members
The Charter Member Circle
We are opening this practice with a deliberately small panel. The first twenty people to join become charter members — and keep founding pricing for their first year. Choose whichever fits you better:
Pay the year up front — best valueTwelve months for the price of ten. $850 for the year on the Young Adult membership, $1,250 on Mid-Life. Two months free, and your rate is locked for the year.
Or stay month-to-monthCharter monthly pricing for your first twelve months: $78/mo Young Adult, $115/mo Mid-Life. No annual commitment.
Charter pricing applies to the Young Adult and Mid-Life memberships. Paying up front saves the most: $850/year instead of $1,020 on Young Adult, $1,250/year instead of $1,500 on Mid-Life. Twenty spots, honored as a real cap — when they are gone, they are gone.
Claim a charter spotDirect Primary Care — adults under 65
Simple monthly memberships providing direct, unhurried access to your Nurse Practitioner.
Have a high-deductible health plan? This is who direct primary care was built for. You are already paying full price for everyday care until your deductible is met — a membership turns that into one predictable monthly fee with unlimited access, while your insurance stays exactly where it belongs: labs, imaging, prescriptions, specialists, and the big unexpected things. And as of January 2026, federal law lets you pay up to $150 per month of a direct primary care membership straight from your HSA — and being in a DPC arrangement no longer disqualifies you from contributing to one.
Charter rate available
Young Adult Membership
Ages 30–45 · billed monthly
$85/mo standard · $1,020/year
$78/mo
Or $850 for the year paid up front — twelve months for the price of ten, the best charter rate. Charter pricing holds for your first year · + $65/mo to add a spouse or partner
For busy professionals, working parents, and active adults who are generally healthy but want a trusted clinician “in their pocket” for quick answers, acute care, and proactive wellness.
- Direct “in-pocket” digital access — unlimited secure portal messaging and text access for rapid advice and triage
- Same-day / next-day telehealth — virtual appointments for acute issues like sinus infections, rashes, minor illnesses, or travel prescriptions
- Urgent-care avoidance triage — after-hours and weekend guidance on whether an issue needs urgent care or the ER, or can be managed safely at home
- Annual comprehensive health audit — a dedicated yearly wellness visit covering baseline metabolic, cardiovascular, and preventive health goals
- Insurance integration — routine labs, imaging, and prescriptions are ordered through your existing health insurance (PPO, HSA/FSA, etc.) at your preferred local pharmacies and facilities
Charter rate available
Mid-Life & Health Navigation
Ages 46–64 · billed monthly
$125/mo standard · $1,500/year
$115/mo
Or $1,250 for the year paid up front — twelve months for the price of ten, the best charter rate. Charter pricing holds for your first year
For adults navigating changing metabolic health, preventive screenings, or early chronic-condition management who want dedicated one-on-one time and care coordination.
- Everything in the Young Adult Membership, plus:
- Two in-person visits included annually — comprehensive clinical exams in the comfort of your home or office
- Proactive preventive care planning — tailored cardiovascular, hormone, and metabolic screening strategies
- Specialist & system navigation — expert advocacy and coordination for local specialists, imaging, and complex referrals
- Expanded telehealth access — routine virtual check-ins for lab reviews and treatment adjustments
Senior Concierge & Primary Care — adults 65+
Specialized geriatric care for older adults, retirees, and individuals managing complex health needs.
Because we participate in Medicare Part B, clinical medical care for seniors is billed directly to Medicare, while our retainer fee covers non-covered amenities and direct mobile access.
Senior Hybrid Concierge
Ages 65+ · retainer + Medicare Part B for clinical visits
$95/mo
For older adults and families who want comprehensive primary care, house calls, and direct access to a board-certified geriatric nurse practitioner.
- Clinical care, billed to Medicare Part B — in-home primary care visits, chronic-condition management, acute sick visits, physical exams, and advance care planning, billed directly to Medicare
- Direct mobile access — direct phone and portal access for rapid questions and after-hours triage
- Extended appointments — unhurried 45–60 minute visits at your kitchen table or living room
- Care & family coordination — continuous updates to family members, healthcare proxies, and local home-health teams
- Medication review & de-prescribing — ongoing polypharmacy audits to reduce side effects and fall risks
- Mobile house calls — primary care delivered at your private home, independent living, or assisted living community in Sonoma Valley
Standalone Age-in-Place Assessment
One-time service · up to 90-minute in-home visit
$395
A comprehensive, non-membership evaluation for families seeking an expert clinical baseline for an aging loved one.
- Up to 90-minute in-home visit — comprehensive health and mobility evaluation
- Home safety walk-through — environmental fall-risk and hazard assessment
- Polypharmacy audit — deep-dive medication review (Beers Criteria) to flag unnecessary pills and risky interactions
- Cognitive & functional screening — baseline memory, mood, and daily-function review
- Personalized care roadmap — detailed care plan and family debrief
Sonoma Valley Nurse Practitioners Group operates on a transparent, relationship-centered model. Memberships for adults under 65 are direct-pay and billed monthly; for seniors 65+, clinical visits are billed to Medicare Part B while the monthly retainer covers non-covered amenities. As of January 2026, up to $150 per month of a direct primary care membership can be paid from an HSA, and most HSA and FSA plans also cover assessments and retainer fees. Questions about how this pairs with your coverage? We’re happy to talk you through it.
Where we visit
Serving the Sonoma Valley
Home visits are available throughout the valley. Not sure if you’re in our service area? Send us a note — we’ll do our best to reach you.
- Sonoma
- Glen Ellen
- Kenwood
- Boyes Hot Springs
- El Verano
- Agua Caliente
- Schellville
- Vineburg
Good questions
Frequently asked questions
What is a DNP, and what can a nurse practitioner do?
A DNP (Doctor of Nursing Practice) is the highest clinical degree in nursing. In California, nurse practitioners evaluate and diagnose conditions, order and interpret tests, prescribe medications, and manage ongoing care. Becky is board-certified in adult-gerontology primary care (AGNP-C) with 20 years dedicated to older adults.
What is Direct Primary Care?
Direct Primary Care (DPC) is a simple, transparent way to pay for care: you work directly with your nurse practitioner through a clear monthly membership fee instead of going through insurance — that’s how our under-65 memberships work. Removing insurance billing means more time at each visit, honest up-front pricing, and direct access to Becky when you need her. For seniors 65+, we pair the same unhurried approach with Medicare Part B.
Do you replace my regular doctor?
Only if you’d like. If you choose an ongoing membership, Becky can serve as your primary care provider — annual exams, prescriptions, and day-to-day medical care. Your specialists always stay exactly as they are, and we coordinate closely with them. If you prefer a one-time assessment instead, we work alongside your existing doctor rather than replacing them.
Who is a good fit for house calls?
Older adults for whom getting to a clinic is difficult or exhausting, people managing several chronic conditions, families who want more time and attention than a 15-minute appointment allows, and anyone recovering after a hospital stay.
How does insurance work for under-65 memberships?
Your monthly membership fee covers all direct clinical communication, telehealth, and primary-care access with Becky Spear, DNP. For outside services — such as blood work, diagnostic imaging (X-rays, MRIs), and prescription medications — we order them using your standard health insurance at your local pharmacy, Quest/Labcorp, or hospital.
How does Medicare work for seniors (65+)?
We bill Medicare Part B directly for your clinical medical visits and house calls. The monthly retainer fee ($95/mo) strictly covers non-covered amenities, such as direct mobile cell/text access, extended visit times, and family care coordination. You remain responsible for standard Medicare deductibles and copays.
How do I pay?
We keep our billing simple, predictable, and transparent.
For standalone services & assessments (such as the Age-in-Place Assessment, LIC 602 pre-admission paperwork, or a standalone medication review), payment is private-pay and due securely at the time of the visit.
For ongoing memberships, your monthly fee is conveniently and automatically billed on a recurring basis, ensuring continuous, unhurried care and direct mobile access to your provider without any surprise costs.
For the Senior Hybrid Concierge tier (65+), clinical visits are billed directly to Medicare Part B — only the monthly retainer is billed to you. More on paying for your visit →
For standalone services & assessments (such as the Age-in-Place Assessment, LIC 602 pre-admission paperwork, or a standalone medication review), payment is private-pay and due securely at the time of the visit.
For ongoing memberships, your monthly fee is conveniently and automatically billed on a recurring basis, ensuring continuous, unhurried care and direct mobile access to your provider without any surprise costs.
For the Senior Hybrid Concierge tier (65+), clinical visits are billed directly to Medicare Part B — only the monthly retainer is billed to you. More on paying for your visit →
I have a high-deductible health plan. Does a membership actually make sense?
This is exactly who direct primary care fits best. With a high deductible, everyday care — the sinus infection, the rash, the lab result you want explained — comes out of your pocket at full price until you hit your deductible, which most people never do. A membership converts that into one predictable monthly fee with unlimited access to Becky, while your insurance keeps doing the job it is actually good at: labs, imaging, prescriptions, specialists, and the large unexpected events. You keep your plan. You just stop paying retail for the small stuff, and stop putting off care because of what it might cost.
Can I use my HSA or FSA?
Yes — and this got significantly better in 2026. As of January 1, 2026, federal law treats a direct primary care arrangement as a qualified medical expense: you can pay up to $150 per month of a DPC membership with tax-free HSA dollars, and being in a DPC arrangement no longer disqualifies you from contributing to an HSA at all. Both of our under-65 memberships fall under that $150 monthly cap. Most Flexible Spending Accounts (FSA) also cover memberships, one-time clinical assessments, and concierge retainer fees. We recommend confirming with your specific plan administrator.
What is the Charter Member Circle?
It is our founding-member offer, and it is capped at twenty people. The first twenty members to join keep founding pricing for their first year — either twelve months for the price of ten if you pay the year up front — $850 for the Young Adult membership or $1,250 for Mid-Life — or charter monthly pricing of $78/mo and $115/mo with no annual commitment. Paying up front is the better deal: it saves $170 a year on Young Adult and $250 on Mid-Life. Twenty is a real cap, not a marketing number: this practice is deliberately small so that visits stay unhurried and Becky answers her own messages. Ask about a charter spot →
What happens at the first visit?
Plan for up to 90 minutes. We review your full health history and every medication, talk through current concerns, look at mobility and safety around the home, and build a care plan around your goals. Family members are welcome to join.
Is Becky a doctor? How is she licensed?
Clinical services at Sonoma Valley Nurse Practitioners Group are provided independently by Rebecca Spear, DNP, AGNP-C, GS-C. Becky is a Doctor of Nursing Practice and a fully independent Nurse Practitioner holding an NP 104 endorsement from the California Board of Registered Nursing. This endorsement authorizes her to comprehensively evaluate, diagnose, manage primary care conditions, and prescribe medications independently, without standardized physician protocols or supervision. Please note that while Becky holds the highest academic clinical doctorate in nursing education, she practices as an advanced practice nurse practitioner, not a medical doctor (MD) or osteopath (DO).
What if I have an emergency?
House calls are not an emergency service. If you are experiencing a medical emergency, call 911 right away.
Get in touch
Request a visit or ask a question
We’d love to hear from you
Whether you’re asking for yourself, a parent, or a neighbor, we’ll get back to you within one business day. No obligation — just a conversation.
Ready to schedule? Request a visit online — the form here is for general questions.
Sonoma Valley, California