EAST BAY VASCULAR MEDICAL GROUP (NPI# 1861503351) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861503351 |
| Entity Type | Organization |
| Organization Name | EAST BAY VASCULAR MEDICAL GROUP |
| Practice Address |
365 Hawthorne Ave Suite 103 Oakland CA 94609-3107 |
| Practice Telephone | 5108326131 |
| Mailing Telephone | 5108326131 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-01-30 |
| Authorized Official Name | NANCI CARTER WEBB (PRACTICE MANAGER) |
| Authorized Official Telephone | 5108326131 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | ZZZ82873Z | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619072923 | East Bay Vascular Medical Group | Surgery | 130 La Casa Via, Ste 201 Bldg 1, Walnut Creek, CA 94598 | 2006-09-13 |
| Street Address |
365 HAWTHORNE AVE SUITE 103 |
| City | OAKLAND |
| State | CA |
| Zip Code | 94609-3107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184686156 | Rupert Roupen Horoupian | Specialist | 365 Hawthorne Ave, Suite 101, Oakland, CA 94609-3107 | 2006-04-05 |
| 1588061378 | First Surgical Consultants | General Acute Care Hospital | 365 Hawthorne Ave, 101, Oakland, CA 94609-3107 | 2014-11-24 |
| 1477826683 | Kelley Lockwood Brennan | Nurse Practitioner | 365 Hawthorne Ave, Suite 301, Oakland, CA 94609-3107 | 2012-02-17 |
| 1891084117 | Debbie Choi Man Chan | Physician Assistant | 365 Hawthorne Ave, #201, Oakland, CA 94609-3107 | 2011-04-07 |
| 1679701858 | Cheruba Prabakar | Obstetrics & Gynecology | 365 Hawthorne Ave, Ste 301, Oakland, CA 94609-3107 | 2009-06-26 |
| 1487813697 | Christa Kong | Physician Assistant | 365 Hawthorne Ave, Suite 201, Oakland, CA 94609-3107 | 2008-06-03 |
| 1922205442 | Associated Neurology Medical Group, Inc. | Psychiatry & Neurology | 365 Hawthorne Ave, Suite 203, Oakland, CA 94609-3107 | 2007-06-28 |
| 1720284011 | Thomas Raymond Hardey | Clinical Neuropsychologist | 365 Hawthorne Ave, Suite 104, Oakland, CA 94609-3107 | 2007-06-22 |
| 1992913859 | Diane Kwan | Surgery | 365 Hawthorne Ave, Suite 101, Oakland, CA 94609-3107 | 2007-05-21 |
| 1598806986 | Douglas Stannage Patton | Surgery | 365 Hawthorne Ave, Suite 101, Oakland, CA 94609 | 2007-02-09 |
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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 | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972614238 | John David Bry | Surgery | 350 30th St Ste 210, Oakland, CA 94609-3425 | 2006-08-31 |
| 1942243308 | Noel L Concepcion | Surgery | 6466 Bayview Dr, Oakland, CA 94605-3134 | 2006-06-14 |
| 1881819258 | Jimmy J.w. Pak | Surgery | 275 W Macarthur, Oakland, CA 94611-5641 | 2007-04-13 |
| 1770694101 | Stephen Norfleet Etheredge | Surgery | 365 Hawthorne Ave, Ste 103, Oakland, CA 94609-3107 | 2006-08-31 |
| 1407967870 | Ronald Lee Webb | Surgery | 365 Hawthorne Ave, Ste 103, Oakland, CA 94609-3107 | 2006-08-31 |
| 1790705705 | Arnold W. Levine | Surgery | 275 W Macarthur, Oakland, CA 94611-5641 | 2006-07-20 |
| 1922092469 | Edward B. Woodward | Surgery | 275 W Macarthur, Oakland, CA 94611-5641 | 2005-09-09 |
| 1235138959 | Enrico C Gonzalez | Surgery | 43 Yawpo Ave, Suite#1, Oakland, NJ 07436-2714 | 2005-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881213817 | Robert Morton Carroll X | Surgery | 2241 Century Hl, Los Angeles, CA 90067-3506 | 2020-04-09 |
| 1992341895 | Surgicalist of Ca PC | Surgery | 3300 E South St Ste 301a, Lakewood, CA 90805-4549 | 2019-11-26 |
| 1528600558 | Kevin M Casey Md Apmc | Surgery | 1919 State St # 204-206, Santa Barbara, CA 93101-2430 | 2019-10-10 |
| 1487117594 | John Nastasi | Surgery | 100 W Valencia Mesa Dr # 211, Fullerton, CA 92835-3768 | 2019-04-08 |
| 1225508385 | Jay Labourene | Surgery | 1550 G Tiburon Blvd, Tiburon, CA 94920-2531 | 2018-12-03 |
| 1467922120 | Paul Bressman Md Inc | Surgery | 1493 S Crest Dr, Los Angeles, CA 90035-3339 | 2018-11-26 |
| 1437638517 | Thousand Oaks Vein Clinic PC | Surgery | 225 N Moorpark Rd Ste C, Thousand Oaks, CA 91360-4320 | 2018-08-09 |
| 1881186377 | Lavs Access Center Inc. | Surgery | 620 W Beverly Blvd Ste B, Montebello, CA 90640-3624 | 2018-05-31 |
| 1841789328 | Sunil Rayan, M.d., Inc. | Surgery | 320 Santa Fe Dr Ste 212, Encinitas, CA 92024-5139 | 2018-05-09 |
| 1245739820 | Northridge Vascular Center A Professional Medical Corporation | Surgery | 19331 Business Center Dr Ste 102, Northridge, CA 91324-3533 | 2018-02-08 |
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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.