Andrea Banouvong

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95013507 Issued in CA

Practice address

927 Via Honda
San Lorenzo, CA 94580-2815

Phone

(510) 407-0749

NPI assigned

May 29, 2020

Last updated

May 29, 2020By the provider in NPPES

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, WA, OR3 enrollments

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 3

Specialty

Nurse Practitioner

Education

University of California, San Francisco School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sutter Bay Medical FoundationGroup PAC ID 4284538778, shared by 16 NPIs, 3,783 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations (25 of 29)

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.

• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1740413798
  Medicare reassignment NPD
• Sutter Bay Medical Foundation

  dba Palo Alto Medial Foundation

  • Multi-Specialty Clinic/Center
  • Palo Alto, CA
  • NPI 1013950807
  Medicare reassignment NPD
• Sutter Bay Medical Foundation

  dba Sutter Samaritan Surgery Center

  • Ambulatory Surgical Clinic/Center
  • San Jose, CA
  • NPI 1033817168
  Medicare reassignment NPD
• Sutter Bay Medical Foundation

  dba Palo Alto Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Palo Alto, CA
  • NPI 1104067115
  Medicare reassignment NPD
• Sutter Bay Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Los Altos, CA
  • NPI 1568851327
  Medicare reassignment NPD
• Sutter Bay Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Mountain View, CA
  • NPI 1982845186
  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1184786527

  WA

  Medicare reassignment NPD
• Sutter Bay Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Fremont, CA
  • NPI 1497996524
  Medicare reassignment
• Sutter Bay Hospitals

  dba Mills-Peninsula Medical Center

  • General Acute Care Hospital
  • Burlingame, CA
  • NPI 1043670334
  NPD
• Sutter Bay Hospitals

  dba Alta Bates Summit Medical Center - Summit Campus

  • Rehabilitation Hospital Unit
  • Oakland, CA
  • NPI 1194171371
  NPD
• Sutter Bay Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • San Carlos, CA
  • NPI 1164840088
  NPD
• Sutter Bay Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Fremont, CA
  • NPI 1306241534
  NPD

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

{
    "created_epoch": "1590710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590710400000",
    "number": "1073137634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "927 VIA HONDA",
            "city": "SAN LORENZO",
            "state": "CA",
            "postal_code": "945802815",
            "telephone_number": "510-407-0749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 VIA HONDA",
            "city": "SAN LORENZO",
            "state": "CA",
            "postal_code": "945802815",
            "telephone_number": "510-407-0749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANOUVONG",
        "first_name": "ANDREA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-29",
        "last_updated": "2020-05-29",
        "certification_date": "2020-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95013507",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95013507",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alan M Linder MD a Medical Corporation
• Gary R Albright, D.M.D
• Nadia Arce-Fernandez, MSW
• Jessica Avery, DPT
• George Albert Baker Jr.
• Bay Area Doula Services LLC
• Bay Mtu (Alameda County CCS)
• Be the Difference Behavior Consulting
• Stephanie Beck
• Edward J Becker, D.D.S.

• Nurse Practitioner in San Lorenzo, CA
• Providers in San Lorenzo, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2020; 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.