EAST BAY FAMILY PRACTICE MEDICAL GROUP INC (NPI# 1154313237) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154313237 |
| Entity Type | Organization |
| Organization Name | EAST BAY FAMILY PRACTICE MEDICAL GROUP INC |
| Practice Address |
3100 Telegraph Ave Ste 2109 Oakland CA 94609-3210 |
| Practice Telephone | 5106459900 |
| Practice Fax Number | 5106459919 |
| Mailing Telephone | 5106459900 |
| Mailing Fax Number | 5106459919 |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. AUDREY D'ANDREA (VICE PRESIDENT SHARE HOLDER) |
| Authorized Official Telephone | 5106459900 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR0003490 | 05 |
| Street Address |
3100 TELEGRAPH AVE STE 2109 |
| City | OAKLAND |
| State | CA |
| Zip Code | 94609-3210 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861091225 | Amberlee Amaral | Registered Nurse | 3100 Telegraph Ave, Oakland, CA 94609-3239 | 2020-10-17 |
| 1699382325 | Carly Callen Dunlap | Registered Nurse | 3100 Telegraph Ave, Oakland, CA 94609-3239 | 2020-09-27 |
| 1356958466 | Minjung Kim | Registered Nurse | 3100 Telegraph Ave, Oakland, CA 94609-3239 | 2020-09-23 |
| 1326654971 | Nathan Namanny | Student in an Organized Health Care Education/Training Program | 3100 Telegraph Ave, Oakland, CA 94609-3239 | 2020-09-18 |
| 1598371486 | Shani Samedi | Registered Nurse | 3100 Telegraph Ave, Oakland, CA 94609-3239 | 2020-09-16 |
| 1831708569 | Lindsay Nishi Fisher | Registered Nurse | 3100 Telegraph Ave, Oakland, CA 94609-3239 | 2020-07-29 |
| 1023636305 | Shi Zhang | Student in an Organized Health Care Education/Training Program | 3100 Telegraph Ave, Oakland, CA 94609-3239 | 2020-07-13 |
| 1235759218 | Michael Matias | Registered Nurse | 3100 Telegraph Ave, Oakland, CA 94609-3239 | 2020-04-20 |
| 1316574239 | Jasdeep Singh Jassar | Student in an Organized Health Care Education/Training Program | 3100 Telegraph Ave, Oakland, CA 94609-3239 | 2020-03-23 |
| 1972143519 | Tiffany Nakata | Physician Assistant | 3100 Telegraph Ave, Oakland, CA 94609-3239 | 2020-01-12 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104457159 | Gerard John-charles Coughlin | Student in an Organized Health Care Education/Training Program | Samuel Merritt University, 3100 Telegraph Avenue, Oakland, CA 94609 | 2020-01-29 |
| 1417502022 | Michael Knittel | Registered Nurse | 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1962057562 | Nicole Kjolby | Registered Nurse | Samuel Merritt College, 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1396208286 | Graham Vallis | Student in an Organized Health Care Education/Training Program | Ucsf Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA 94609 | 2019-04-09 |
| 1386129526 | Gary Mitchell Snider | Counselor | 390 40th Street, Oakland, CA 94609 | 2018-10-02 |
| 1720568389 | Lice Control Inc. | Technician | 6557 Shattuck Ave, Oakland, CA 94609 | 2018-08-14 |
| 1528559150 | Jenna Marie Kincaid | Behavior Technician | 400 29th St., 204, Oakland, CA 94609 | 2018-05-18 |
| 1336656669 | Nicholas Dicarlo | Social Worker | 465 34th St Ste 6, Oakland, CA 94609 | 2018-01-09 |
| 1174045744 | Theodora J Marzouk | Home Health Aide | 3317 Elm Street, Suite 202, Oakland, CA 94609 | 2017-07-14 |
| 1740728922 | Elena Gardella | Marriage & Family Therapist | 411 30th Street, Suite 412, Oakland, CA 94609 | 2017-02-07 |
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| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
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| 1952942575 | Roots Community Health Center | Family Medicine | 583 5th St Ste A, Oakland, CA 94607 | 2019-10-04 |
| 1699287334 | Ann Blackwell | Family Medicine | 7312 Hillmont Dr, Oakland, CA 94605-2928 | 2017-11-03 |
| 1134579170 | Jonathan Patberg | Family Medicine | 350 Hawthorne Ave Rm 2308, Oakland, CA 94609-3108 | 2016-06-21 |
| 1003279068 | Van T Vu | Family Medicine | 250 E 18th Street, 2nd Floor, Oakland, CA 94606-1716 | 2016-03-29 |
| 1831559509 | Hospital & Medical Foundation of Paris, Inc. | Family Medicine | 5 S. Walnut St., Oakland, IL 61943 | 2016-02-24 |
| 1356729826 | Carroll-anne Heins | Family Medicine | 3600 Broadway Ste 43, Oakland, CA 94611-5730 | 2015-05-15 |
| 1568849743 | Wei (wendy) Diao | Family Medicine | 1800 Harrison St Fl 9th, Oakland, CA 94612 | 2015-04-27 |
| 1902292030 | Xiaoshuang Chen | Family Medicine | 835 Webster Street, Oakland, CA 94607-4219 | 2015-04-15 |
| 1356734859 | Christina Gomez-mira | Family Medicine | 532 Chetwood St, Oakland, CA 94610-1428 | 2015-03-09 |
| 1669875498 | Richard Kreutzer | Family Medicine | 7100 Homewood Dr, Oakland, CA 94611-1411 | 2014-10-07 |
| Find all providers in OAKLAND | ||||
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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.