Pacific Brain & Spine Med GRP Inc

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

Legal business name

PACIFIC BRAIN & SPINE MED GRP INC

Practice address

20055 Lake Chabot Rd
# 110
Castro Valley, CA 94546

Phone

(510) 886-3138

Fax

(510) 373-1616

NPI assigned

Apr 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeffrey Blaine Randall, MD

Title

President

Phone

(510) 886-3138

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elise Pellett, PT, DPT

  • Physical Therapist
  • Lafayette, CA
  • NPI 1124633060
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023075678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20055 LAKE CHABOT RD",
            "address_2": "# 110",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "94546",
            "telephone_number": "510-886-3138",
            "fax_number": "510-373-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20055 LAKE CHABOT RD",
            "address_2": "# 110",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "94546",
            "telephone_number": "510-886-3138",
            "fax_number": "510-373-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC BRAIN & SPINE MED GRP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RANDALL",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "BLAINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-886-3138",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christy Lee Ortzow, OTR/L
• Erin M Osanna-Barba, LCSW
• Gary Allan Osias, O.D.
• Soleiman Osman, DO
• Our Safehaven
• Pacific Critical Care & Neurocritical Care Specialists, Inc
• Sophia Ysabel Pagaduan
• Shalini Rao Paka
• Monica Prisila Palos
• Olivia Pan, M.D.

• Neurological Surgery Physician in Castro Valley, CA
• Providers in Castro Valley, CA by specialty
• Neurological Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.