Associated Internal Medicine Med GRP Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

G84227 Issued in CA

Legal business name

ASSOCIATED INTERNAL MEDICINE MED GRP INC

Practice address

100 Bay PL
Oakland, CA 94610-4448

Phone

(510) 891-8519

Fax

(510) 891-8518

NPI assigned

Dec 19, 2007

Last updated

Jan 3, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Dean J. Nickles, M.D.

Title

President

Phone

(510) 465-6700

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199318400000",
    "number": "1043494651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 30TH ST",
            "address_2": "SUITE 320",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093424",
            "telephone_number": "510-465-6700",
            "fax_number": "510-465-7765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BAY PL",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946104448",
            "telephone_number": "510-891-8519",
            "fax_number": "510-891-8518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED INTERNAL MEDICINE MED GRP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-19",
        "last_updated": "2008-01-03",
        "status": "A",
        "authorized_official_last_name": "NICKLES",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-465-6700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G84227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "ZZZ18981Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Oakland, CA
• Providers in Oakland, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; 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.