Individual provider Active NPI

Jennivy Rapanut Tabbay

  • Family Nurse Practitioner
  • Oakland, CA
National Provider Identifier
1093561664
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95029417 Issued in CA
Practice address
3100 Telegraph Ave
Oakland, CA 94609-3239
Phone
(800) 607-6377
NPI assigned
Apr 25, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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 95029417 CA Primary

Addresses

Primary practice location

3100 Telegraph Ave
Oakland, CA 94609-3239

Mailing address

3100 Telegraph Ave
Oakland, CA 94609-3239

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
I20241223002264 CA Practitioner - Nurse Practitioner 6406383934 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carbon Health Medical Group of California PCGroup PAC ID 9032340047, 335 clinicians

Practice addresses (Care Compare)

701 Sunrise Ave
Roseville, CA 95661-4502
Phone (916) 772-6337

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95029417CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carbon Health Medical Group of California PC CurrentSince Nov 2, 2024 Accepting new patients

Locations

2920 Telegraph Ave
Ste 100
Berkeley, CA 94705
Phone (415) 549-0212

4156 Manzanita Ave
Ste 100
Carmichael, CA 95608
Phone (916) 483-5400

401 Grand Ave
#1112
Oakland, CA 94610
Phone (800) 756-4206

701 Sunrise Ave
Roseville, CA 95661
Phone (916) 483-5400

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1714003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1093561664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 TELEGRAPH AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 TELEGRAPH AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093239",
            "telephone_number": "800-607-6377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABBAY",
        "first_name": "JENNIVY",
        "middle_name": "RAPANUT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-25",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95029417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.