EAST BAY CARDIAC SURGERY CENTER MEDICAL GROUP (NPI# 1609986777) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609986777 |
| Entity Type | Organization |
| Organization Name | EAST BAY CARDIAC SURGERY CENTER MEDICAL GROUP |
| Other Organization Name | IVERSON & STANTEN CARDIAC & THORACIC SURGERY MEDICAL GROUP |
| Practice Address |
3300 Webster St Suite 500 Oakland CA 94609-3117 |
| Practice Telephone | 5104656600 |
| Practice Fax Number | 5108390806 |
| Mailing Telephone | 5104656600 |
| Mailing Fax Number | 5108390806 |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2015-03-10 |
| Authorized Official Name | DR. JUNAID HAMEED KHAN (MANAGING PARTNER) |
| Authorized Official Telephone | 5104656600 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR0060340 | 05 | |
| CA | BLUE SHIELD GRP PROVIDER# | ZZZ03169Z | 01 |
| Other Name | Type Code |
|---|---|
| Iverson & Stanten Cardiac & Thoracic Surgery Medical Group | Former Legal Business Name - Organization |
| Street Address |
3300 WEBSTER ST SUITE 500 |
| City | OAKLAND |
| State | CA |
| Zip Code | 94609-3117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073517603 | James K. Mooney | Specialist | 3300 Webster St, Ste 710, Oakland, CA 94609-3117 | 2005-06-10 |
| 1174970461 | Malboubi Dental Corporation | Dentist | 3300 Webster St, Suite 905, Oakland, CA 94609-3117 | 2016-05-17 |
| 1245607456 | Hill Health Inc A Medical Corporation | Family Medicine | 3300 Webster St, Oakland, CA 94609-3117 | 2015-08-24 |
| 1669879714 | Catherine Logan Maier | Registered Nurse | 3300 Webster St, Suite 1200, Oakland, CA 94609-3117 | 2014-12-03 |
| 1124420658 | Brianna Nicole Cosentino | Physical Therapist | 3300 Webster St, 1201, Oakland, CA 94609-3117 | 2014-09-16 |
| 1477966919 | Jessica Tice | Physical Therapist | 3300 Webster St, 703, Oakland, CA 94609-3117 | 2014-06-03 |
| 1205174505 | Kelly Lee Wong | Internal Medicine | 3300 Webster St, 1000, Oakland, CA 94609-3117 | 2013-01-21 |
| 1770885741 | Rachel L Kay | Nurse Practitioner | 3300 Webster St, Suite 304, Oakland, CA 94609-3117 | 2010-11-24 |
| 1306146568 | Carolyn Jacobs Bernstein | Nurse Practitioner | 3300 Webster St, Oakland, CA 94609-3117 | 2010-10-21 |
| 1528378460 | John Alexander Gillean | Psychiatry & Neurology | 3300 Webster St, Suite 402, Oakland, CA 94609-3117 | 2010-10-13 |
| Find all providers in the same location | ||||
| 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 |
| Find all providers in zip 94609 | ||||
| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689832610 | Coyness L. Ennix Jr., M.d., Inc. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 3300 Webster St, Suite 404, Oakland, CA 94609-3117 | 2008-05-27 |
| 1518017334 | Paul Smith | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 280 W Macarthur Blvd, Oakland, CA 94611-5642 | 2007-01-12 |
| 1689753394 | Hon S. Lee | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 280 W Macarthur Blvd, Oakland, CA 94611-5642 | 2006-11-03 |
| 1003994898 | John L. Jones | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 280 W Macarthur Blvd, Oakland, CA 94611-5642 | 2006-11-01 |
| 1346328135 | Dennis S. Durzinsky | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 275 W Macarthur, Oakland, CA 94611-5641 | 2006-11-01 |
| 1952489726 | Steven G. Granelli | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 280 W Macarthur Blvd, Oakland, CA 94611-5642 | 2006-11-01 |
| 1235217035 | David Alyono | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 280 W Macarthur Blvd, Oakland, CA 94611-5642 | 2006-11-01 |
| 1902984701 | Steven F. Webster | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 280 W Macarthur Blvd, Oakland, CA 94611-5642 | 2006-11-01 |
| 1760574917 | Barry B Sheppard | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 3300 Webster St, Suite 500, Oakland, CA 94609-3117 | 2006-09-28 |
| 1740372770 | Russell David Stanten | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 3300 Webster St, Suite 500, Oakland, CA 94609-3117 | 2006-09-28 |
| Find all providers in OAKLAND | ||||
Please comment or provide details below to improve the information on EAST BAY CARDIAC SURGERY CENTER MEDICAL GROUP.
| 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.