NPIMap

Organization Active NPI

West Coast Retina Medical Group, Inc.

Doing business as West Coast Retina

  • Retina Specialist (Ophthalmology) Physician
  • San Francisco, CA
National Provider Identifier
1053389064
Registry record updated Feb 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
WEST COAST RETINA MEDICAL GROUP, INC.
Doing business as
West Coast Retina
Practice address
1445 Bush St
San Francisco, CA 94109-5520
Phone
(415) 972-4600
Fax
(415) 975-0999
NPI assigned
Mar 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2020

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

Authorized official

Name
Benjamin M HigginbothamNPI 1659957819
Title
Coo
Phone
(415) 972-4626

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X
Retina Specialist (Ophthalmology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207WX0107X Primary
Uveitis and Ocular Inflammatory Disease (Ophthalmology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207WX0108X

Addresses

Primary practice location

1445 Bush St
San Francisco, CA 94109-5520

Mailing address

1445 Bush St
San Francisco, CA 94109-5520
Phone (415) 972-4600

Other practice location 1

101 S San Mateo Dr Ste 265
San Mateo, CA 94401-3819
Phone (650) 342-7137

Other practice location 2

100 Tamal Plz Ste 120
Corte Madera, CA 94925-1176
Phone (415) 927-6600

Other practice location 3

1981 N Broadway Ste 265
Walnut Creek, CA 94596-3827
Phone (925) 295-1727

Other practice location 4

400 30th St
Oakland, CA 94609-3306
Phone (510) 268-8277

Other names 1

  • West Coast Retina Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040412001540 CA Part B Supplier - Clinic/Group Practice 6608860713 Receives reassigned benefits from 7 practitioners
Practice locations: Corte Madera, CA; Oakland, CA; San Francisco, CA; San Mateo, CA; Sonoma, CA; Walnut Creek, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2104668West Coast Retina Medical Group, Inc.1445 Bush St, San Francisco, CA 94109Certificate of waiverMay 21, 2028

National Provider Directory

National Provider Directory

Locations

1800 Sullivan Ave
Rm 507
Daly City, CA 94015
Phone (650) 994-2700

5 Bon Air Rd
Ste 127
Larkspur, CA 94939
Phone (415) 927-3030

400 29th St
Ste 508
Oakland, CA 94609
Phone (510) 268-8277

400 30th St
Ste 402
Oakland, CA 94609
Phone (415) 972-4600

185 Berry St
#9854
San Francisco, CA 94107

1 Daniel Burnham Ct
Ste 210C
San Francisco, CA 94109
Phone (415) 441-0906

101 S San Mateo Dr
Ste 265
San Mateo, CA 94401
Phone (650) 342-7137

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Interoperability endpoints

  • Direct secure messaging: alin@westcoastretina.intellechartdirect.net
  • Direct secure messaging: pbhatter@westcoastretina.intellechartdirect.net
  • Direct secure messaging: mpasricha@westcoastretina.intellechartdirect.net
  • Direct secure messaging: jkircher@westcoastretina.intellechartdirect.net
  • Direct secure messaging: gkamboj@westcoastretina.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580688000000",
    "number": "1053389064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1445 BUSH ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941095520",
            "telephone_number": "415-972-4600",
            "fax_number": "415-975-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 BUSH ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941095520",
            "telephone_number": "415-972-4600",
            "fax_number": "415-975-0999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 S San Mateo Dr Ste 265",
            "address_purpose": "LOCATION",
            "city": "San Mateo",
            "state": "CA",
            "postal_code": "944013819",
            "country_code": "US",
            "telephone_number": "650-342-7137",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Tamal Plz Ste 120",
            "address_purpose": "LOCATION",
            "city": "Corte Madera",
            "state": "CA",
            "postal_code": "949251176",
            "country_code": "US",
            "telephone_number": "415-927-6600",
            "fax_number": "415-891-3329",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1981 N Broadway Ste 265",
            "address_purpose": "LOCATION",
            "city": "Walnut Creek",
            "state": "CA",
            "postal_code": "945963827",
            "country_code": "US",
            "telephone_number": "925-295-1727",
            "fax_number": "925-954-7029",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 30th St",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946093306",
            "country_code": "US",
            "telephone_number": "510-268-8277",
            "fax_number": "510-350-8803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WEST COAST RETINA MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-08",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A",
        "authorized_official_last_name": "HIGGINBOTHAM",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "415-972-4626"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207WX0108X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Uveitis and Ocular Inflammatory Disease",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Coast Retina",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Francisco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.