PACIFIC BRAIN & SPINE MED GRP INC (NPI# 1023075678) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023075678 |
| Entity Type | Organization |
| Organization Name | PACIFIC BRAIN & SPINE MED GRP INC |
| Practice Address |
20055 Lake Chabot Rd # 110 Castro Valley CA 94546 |
| Practice Telephone | 5108863138 |
| Practice Fax Number | 5103731616 |
| Mailing Telephone | 5108863138 |
| Mailing Fax Number | 5103731616 |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. JEFFREY BLAINE RANDALL (PRESIDENT) |
| Authorized Official Telephone | 5108863138 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207T00000X | Neurological Surgery | Allopathic & Osteopathic Physicians |
| Street Address |
20055 LAKE CHABOT RD # 110 |
| City | CASTRO VALLEY |
| State | CA |
| Zip Code | 94546 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770572760 | Michael Edward Nickas | Urology | 20055 Lake Chabot Rd, #100, Castro Valley, CA 94546-5331 | 2005-10-21 |
| 1225571771 | University Healthcare Alliance | Internal Medicine | 20055 Lake Chabot Rd, Suite 130, Castro Valley, CA 94546-5331 | 2016-11-30 |
| 1346656832 | Connie Hwa Chen | Registered Nurse | 20055 Lake Chabot Rd, Suite 130, Castro Valley, CA 94546-5331 | 2014-07-07 |
| 1427481522 | Peter Adamczyk, Md, Inc. | Psychiatry & Neurology | 20055 Lake Chabot Rd, Suite 300, Castro Valley, CA 94546-5331 | 2013-08-13 |
| 1366795395 | Tara Marie Jordan | Physician Assistant | 20055 Lake Chabot Rd, Suite 130, Castro Valley, CA 94546-5331 | 2012-10-15 |
| 1376802579 | Thomas R Powers Md. Inc | Psychiatric Hospital | 20055 Lake Chabot Rd, Suite 350, Castro Valley, CA 94546-5331 | 2012-05-08 |
| 1467731828 | Gene-yuan Chang | Internal Medicine | 20055 Lake Chabot Rd, 230, Castro Valley, CA 94546-5331 | 2011-08-16 |
| 1750681714 | Joanna Randolph | Nurse Practitioner | 20055 Lake Chabot Rd, Suite 230, Castro Valley, CA 94546-5331 | 2010-10-25 |
| 1568696987 | Doctors Medical Surgical Associates | Specialist | 20055 Lake Chabot Rd, Suite 200, Castro Valley, CA 94546-5331 | 2009-05-13 |
| 1407051584 | Daniel B. Allen, M.d., Inc. | Specialist | 20055 Lake Chabot Rd, Suite 240, Castro Valley, CA 94546-5331 | 2007-06-18 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861991234 | For Your Eyes Only Ophthalmic Medical Corp. | Optometrist | 2687 Castro Valley Blvd., Castro Valley, CA 94546 | 2018-02-12 |
| 1821536954 | Webster Surgery Center, Lp | Clinic/Center | 20998 Redwood Dr, Castro Valley, CA 94546 | 2017-02-09 |
| 1639506215 | Jennifer Lee | Pharmacist | 20629 Redwood Road, Castro Valley, CA 94546 | 2013-09-27 |
| 1679860506 | Lauren Nicole Hill | Counselor | 20212 Redwood Rd Ste 104, Castro Valley, CA 94546 | 2011-06-29 |
| 1326330952 | Jeannette Villalobos | Counselor | 5248 Crane Avenue, Castro Valley, CA 94546 | 2011-05-16 |
| 1780992560 | Cherie Christine-vivona Clark | Physician Assistant | Eden Emergency Department, 20103 Lake Chabot Road, Castro Valley, CA 94546 | 2010-09-15 |
| 1518287218 | Rite Aid Incorporation | Community/Behavioral Health | 3548 Castro Valley Blv, Castro Valley, CA 94546 | 2010-06-03 |
| 1770719940 | Kristina Marie Sotto | Occupational Therapist | 20259 Lake Chabot Road, Castro Valley, CA 94546 | 2009-06-02 |
| 1861664203 | Bannanje R Nayak | Physical Medicine & Rehabilitation | 19830 Lake Chabot Road, Ste C, Castro Valley, CA 94546 | 2008-03-26 |
| 1205030202 | Yvonne Marie Jones | Social Worker | 2055 Fairmont Dr., San Leandro, CA 94546 | 2007-06-13 |
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| Taxonomy Code | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821043498 | Ronnie Isaac Mimran | Neurological Surgery | 20055 Lake Chabot Rd, #110, Castro Valley, CA 94546 | 2006-05-23 |
| 1083669592 | Lawrence David Dickinson | Neurological Surgery | 20055 Lake Chabot Rd, # 110, Castro Valley, CA 94546 | 2006-05-23 |
| 1720046295 | Jeffrey Blaine Randall | Neurological Surgery | 20055 Lake Chabot Rd, # 110, Castro Valley, CA 94546 | 2006-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144477 | Faculty Physicians and Surgeons of Llusm | Neurological Surgery | 35400 Bob Hope Dr Ste 110, Rancho Mirage, CA 92270-1772 | 2020-11-04 |
| 1013524123 | Hubert Tsun-yin Lee | Neurological Surgery | 1201 Welch Road, Stanford, CA 94305-5327 | 2020-09-24 |
| 1811500267 | Chaparral Medical Group, Inc. | Neurological Surgery | 9120 Haven Ave Ste 201, Rancho Cucamonga, CA 91730-5413 | 2020-08-26 |
| 1982259461 | Mauricio Mandel Brigido | Neurological Surgery | 300 Pasteur Dr # R281, Stanford, CA 94305-2200 | 2019-08-01 |
| 1538713227 | Sylvain Palmer Md Inc | Neurological Surgery | 26732 Crown Valley Pkwy Ste 541, Mission Viejo, CA 92691-6376 | 2019-07-31 |
| 1851945877 | X.sean Xin, Do Inc. | Neurological Surgery | 7230 Med Ctr Dr Ste 600, West Hills, CA 91307-4017 | 2019-07-29 |
| 1154974525 | Jan M. Eckermann, Md Inc. | Neurological Surgery | 1617 W Cliff Dr, Ste 203, Newport Beach, CA 92660 | 2019-07-24 |
| 1598317711 | Newport Beach Neurosurgical Institute | Neurological Surgery | 1501 Superior Ave Ste 214b, Newport Beach, CA 92663-3600 | 2019-07-09 |
| 1609438761 | Py26 Neurosurgery, PC | Neurological Surgery | 120 S Spalding Dr Ste 305, Beverly Hills, CA 90212-1800 | 2019-06-28 |
| 1679133664 | Sequoia Neurosurgery, Inc. | Neurological Surgery | 306 N Conyer St Ste A, Visalia, CA 93291-4704 | 2019-06-20 |
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| City | CASTRO VALLEY |
| Zip Code | 94546 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.