Individual provider Active NPI

Ann Marie Daleiden, NP

  • Gerontology Nurse Practitioner
  • Oakland, CA
National Provider Identifier
1093815540
Registry record updated Jun 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
NP14287 Issued in CA
Practice address
350 30TH St
Suite 407
Oakland, CA 94609-3424
Phone
(510) 419-0230
NPI assigned
Sep 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X NP14287 CA Primary

Addresses

Primary practice location

350 30TH St
Suite 407
Oakland, CA 94609-3424

Mailing address

350 30TH St
Suite 407
Oakland, CA 94609-3424
Phone (510) 419-0230

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ07022ZOtherCAPTAN

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
I20041006000848 CA Practitioner - Nurse Practitioner 7214996172 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NP14287CAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hill Health Inc a Medical Corporation CurrentSince Mar 15, 2018 Accepting new patients
Family Practice Medical Group of Oakland Past Accepting new patients
Cardinal Primary Care Medical Group, Inc PastSince Dec 1, 2010 Accepting new patients

Locations

350 30th St
Ste 407
Oakland, CA 94609
Phone (510) 419-0230

3300 Webster St
Ste 1000
Oakland, CA 94609
Phone (510) 271-4400

Organizations & group practices 3

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": "1159056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466380800000",
    "number": "1093815540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 30TH ST",
            "address_2": "SUITE 407",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093424",
            "telephone_number": "510-419-0230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 30TH ST",
            "address_2": "SUITE 407",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093424",
            "telephone_number": "510-419-0230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALEIDEN",
        "first_name": "ANN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-24",
        "last_updated": "2016-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "NP14287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "ZZZ07022Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.