Organization Active NPI

California Spine Center a Professional Medical Corporation

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Walnut Creek, CA
National Provider Identifier
1114149341
Registry record updated Oct 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
A85014 Issued in CA
Legal business name
CALIFORNIA SPINE CENTER A PROFESSIONAL MEDICAL CORPORATION
Practice address
2123 Ygnacio Valley Road
Building K, Suite 200
Walnut Creek, CA 94598
Phone
(925) 926-0195
Fax
(925) 926-0194
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2015

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

Authorized official

Name
Mr. David W. Chow, M.D.NPI 1700823762
Title
Owner/Provider
Phone
(925) 926-0195

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208100000X A85014 CA
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2081P2900X A85014 CA Primary

Addresses

Primary practice location

2123 Ygnacio Valley Road
Building K, Suite 200
Walnut Creek, CA 94598

Mailing address

2123 Ygnacio Valley Road
Building K, Suite 200
Walnut Creek, CA 94598
Phone (925) 926-0195

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070919000612 CA Part B Supplier - Clinic/Group Practice 2860586096 Receives reassigned benefits from 3 practitioners
Practice locations: Brentwood, CA; Pleasanton, CA; San Diego, CA; Stockton, CA; Walnut Creek, CA

National Provider Directory

National Provider Directory

Locations

100 Cortona Way
Ste 100
Brentwood, CA 94513

100 Cortona Way
Ste 160
Brentwood, CA 94513
Phone (925) 677-0541

2800 N California St
#17A
Stockton, CA 95204

2800 N California St
Ste 17
Stockton, CA 95204
Phone (209) 451-0801

2800 N California St
Ste 15A
Stockton, CA 95204

1455 Montego
Ste 204
Walnut Creek, CA 94598
Phone (510) 866-8320

2123 Ygnacio Valley Rd
Ste 200
Walnut Creek, CA 94598

2123 Ygnacio Valley Rd
#200
Walnut Creek, CA 94598

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444003200000",
    "number": "1114149341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2123 YGNACIO VALLEY ROAD",
            "address_2": "BUILDING K, SUITE 200",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "94598",
            "telephone_number": "925-926-0195",
            "fax_number": "925-926-0194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2123 YGNACIO VALLEY ROAD",
            "address_2": "BUILDING K, SUITE 200",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "94598",
            "telephone_number": "925-926-0195",
            "fax_number": "925-926-0194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA SPINE CENTER A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2015-10-05",
        "status": "A",
        "authorized_official_last_name": "CHOW",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "925-926-0195",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "A85014",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "CA",
            "license": "A85014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2015; 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.