NPIMap

Organization Active NPI

Bay Area Retina Associates, Medical Group

  • Retina Specialist (Ophthalmology) Physician
  • San Leandro, CA
National Provider Identifier
1083857353
Registry record updated May 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
BAY AREA RETINA ASSOCIATES, MEDICAL GROUP
Practice address
15051 Hesperian Blvd Ste D
San Leandro, CA 94578-3536
Phone
(510) 317-1111
Fax
(510) 317-1113
NPI assigned
Apr 15, 2009
Last updated
May 23, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
BAY AREA RETINA ASSOCIATES, MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 23, 2021

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

Authorized official

Name
Ms. Agnes Mercado, CRCS
Title
Director of Revenue Cycle
Phone
(925) 265-8324

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Retina Specialist (Ophthalmology) Physician 207WX0107X NU Primary

Addresses

Primary practice location

15051 Hesperian Blvd Ste D
San Leandro, CA 94578-3536

Mailing address

365 Lennon LN Ste 250
Walnut Creek, CA 94598-5915
Phone (925) 265-8324

Other identifiers 2

IdentifierTypeStateIssuer
GR0030671MedicaidCA
GR0030670MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081024000116 CA Part B Supplier - Clinic/Group Practice 8527956580 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Walnut Creek, CA; Vallejo, CA; Fremont, CA; Vacaville, CA; Tracy, CA; San Leandro, CA; Pleasanton, CA; Oakland, CA…

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Bay Area Retina Associates4 organizations share this tax ID, including this one
Part of
Bay Area Retina Associates

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4049 Lone Tree Way
Ste Ij
Antioch, CA 94531
Phone (800) 573-8462

39055 Hastings St
Ste 105
Fremont, CA 94538
Phone (510) 505-1430

15051 Hesperian Blvd
Ste D
San Leandro, CA 94578
Phone (510) 317-1111

2160 W Grant Line Rd
Ste 240
Tracy, CA 95377
Phone (209) 833-6118

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1239753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621728000000",
    "number": "1083857353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 LENNON LN STE 250",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945985915",
            "telephone_number": "925-265-8324",
            "fax_number": "925-522-8658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15051 HESPERIAN BLVD STE D",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945783536",
            "telephone_number": "510-317-1111",
            "fax_number": "510-317-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY AREA RETINA ASSOCIATES, MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAY AREA RETINA ASSOCIATES, MEDICAL GROUP",
        "enumeration_date": "2009-04-15",
        "last_updated": "2021-05-23",
        "certification_date": "2021-05-23",
        "status": "A",
        "authorized_official_last_name": "MERCADO",
        "authorized_official_first_name": "AGNES",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "925-265-8324",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CRCS"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030671",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030670",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Leandro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.