Individual provider Active NPI

Sivan Sadeh, FNP-C

  • Family Nurse Practitioner
  • Oakland, CA
National Provider Identifier
1053080309
Registry record updated Sep 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95018356 Issued in CA
Practice address
3451 E 12TH St
Oakland, CA 94601-3463
Phone
(510) 535-3500
NPI assigned
Sep 9, 2021
Last updated
Sep 9, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95018356 CA Primary

Addresses

Primary practice location

3451 E 12TH St
Oakland, CA 94601-3463

Mailing address

3272 Knowland Ave
Oakland, CA 94619-2630
Phone (323) 376-0564

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210929002497 CA Practitioner - Nurse Practitioner 8325445612 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
La Clinica de la Raza IncGroup PAC ID 1557258282, 130 clinicians

Practice addresses (Care Compare)

3451 E 12TH St
Oakland, CA 94601-3463
Phone (510) 535-3500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
La Clinica de la Raza Inc CurrentSince Oct 1, 2021 Accepting new patients
La Clinica de la Raza Inc Current Accepting new patients
La Clinica de la Raza Inc CurrentSince Oct 1, 2021 Accepting new patients

Locations

3451 E 12th St
Oakland, CA 94601
Phone (510) 535-3319

3451 E 12th St
Fl 2
Oakland, CA 94601
Phone (510) 535-3319

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1053080309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3272 KNOWLAND AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946192630",
            "telephone_number": "323-376-0564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3451 E 12TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946013463",
            "telephone_number": "510-535-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SADEH",
        "first_name": "SIVAN",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-09",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95018356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.