Alexandra Alabata Ingram, P.A.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

355 Lennon LN
Suite 295
Walnut Creek, CA 94598

Phone

(925) 357-9786

Fax

(925) 217-7956

NPI assigned

Aug 30, 2012

Last updated

Nov 26, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Alexandra Alabata Sanborn Former name

Electronic endpoints 2

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

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Golden State Dermatology Associates, Inc.Group PAC ID 1052418175, 118 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

99.15 of 100Reported as group

Promoting interoperability

99

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: alexandra.ingram@forefrontdermatology.emadirect.md
• FHIR API: https://forefrontdermatology.mmi.prod.fhir.ema-api.com/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.

• Golden State Dermatology Associates Inc.

  • Dermatology Physician
  • Walnut Creek, CA
  • NPI 1700860871
  Medicare reassignment Care Compare group
• Golden State Dermatology Associates, Inc.

  • Ambulatory Surgical Clinic/Center
  • Fresno, CA
  • NPI 1235738576
  NPD
• California Pacific Medical Group, Inc.

  dba Brown & Toland Medical Group

  • Multi-Specialty Clinic/Center
  • Oakland, CA
  • NPI 1275002453
  NPD (past)
• John Muir Health

  • Rehabilitation Hospital Unit
  • Walnut Creek, CA
  • NPI 1447269303
  NPD (past)
• Munyon Dermatology

  • Dermatology Physician
  • San Mateo, CA
  • NPI 1437422391
  NPD (past)

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

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1063761500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 LENNON LN",
            "address_2": "SUITE 295",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "94598",
            "telephone_number": "925-357-9786",
            "fax_number": "925-217-7956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 LENNON LN",
            "address_2": "SUITE 295",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "94598",
            "telephone_number": "925-357-9786",
            "fax_number": "925-217-7956"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8573 County Road 64",
            "address_purpose": "LOCATION",
            "city": "Daphne",
            "state": "AL",
            "postal_code": "365268706",
            "country_code": "US",
            "telephone_number": "251-621-2244",
            "fax_number": "251-621-7209",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "INGRAM",
        "first_name": "ALEXANDRA",
        "middle_name": "ALABATA",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-30",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "PA1466",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "PA.1466",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9106852",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007248400",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Alexandra.Ingram@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "8573 County Road 64",
            "city": "Daphne",
            "state": "AL",
            "country_code": "US",
            "postal_code": "365268706",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Alexandra.Ingram@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "580 Providence Park Dr E Fl 2",
            "city": "Mobile",
            "state": "AL",
            "country_code": "US",
            "postal_code": "36695",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ALEXANDRA",
            "last_name": "SANBORN",
            "middle_name": "ALABATA",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Inadvance Medicine Associates West, P. C. (Passport Health)
• Sophia Incze
• Infectious Disease Doctors Medical Group Apc
• Infinite Growth Child and Family Therapy Inc.
• Tatiana Ingco
• Corrie Ingram, LMFT
• Emily Ingram
• Jorge Inguez, MA
• Inner Light House LLC
• Innovative Wellness Inc a Nursing Corporation

• Surgical Physician Assistant in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Surgical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; 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.