Ji Yeong Gendron Song

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95017511 Issued in CA

Practice address

738 Bancroft Road
Walnut Creek, CA 94598-1250

Phone

(925) 938-8525

NPI assigned

Jun 24, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

76.8 of 100Reported as group

Quality

65.04

Improvement activities

40

Cost

86.74

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/9743/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bay Area PL Services

  • Emergency Medicine Physician
  • San Bruno, CA
  • NPI 1932858628
  Medicare reassignment NPD
• The Davis Street Community Center Incorporated

  dba Davis Street Primary Care Clinic

  • Federally Qualified Health Center (FQHC)
  • San Leandro, CA
  • NPI 1215358924
  Medicare reassignment NPD
• Bay Area PL Services

  • Clinical Medical Laboratory
  • San Bruno, CA
  • NPI 1972088581
  NPD

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

{
    "created_epoch": "1624492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1033788898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "738 BANCROFT ROAD",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "94598",
            "telephone_number": "925-938-8525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "738 BANCROFT ROAD",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945981250",
            "telephone_number": "925-938-8525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENDRON SONG",
        "first_name": "JI YEONG",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-24",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95017511",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95017511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Geleris, D.D.S.
• Anna Geller
• Sofia Ysabel Geluz
• Heather Scott Gemmer, M.A., CCC-A
• Karna Gendo, M.D.
• Leah Lisa Geneza, PT, DPT
• George James Counelis MD Inc (Bay Area Neurosciences)
• David Louis George
• Patricia Ann Geraghty, N.P.
• Gerald L Tarder, MD a Professional Corporation

• Family Nurse Practitioner in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.