Individual provider Active NPI

Michael David Genualdi, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Berkeley, CA
National Provider Identifier
1124482823
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
A151396 Issued in CA
Practice address
1901 4TH St Ste 201
Berkeley, CA 94710-1986
Phone
(510) 929-1400
NPI assigned
Apr 8, 2016
Last updated
Jun 28, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X A151396 CA Primary

Addresses

Primary practice location

1901 4TH St Ste 201
Berkeley, CA 94710-1986

Mailing address

PO Box 511250
Los Angeles, CA 90051-7805
Phone (510) 929-1400

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200914001181 CA Practitioner - Internal Medicine 0143648790 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
New York Medical College, 2016
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1144 65TH St
Suite F
Oakland, CA 94608-1053

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A151396CAMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Park Health, Inc Internal Medicine CurrentSince Mar 15, 2024 Accepting new patients

Locations

1901 4th St
Ste 201
Berkeley, CA 94710
Phone (469) 401-8820

22445 Cupertino Rd
Cupertino, CA 95014
Phone (408) 253-4300

3850 Walnut Ave
Fremont, CA 94538
Phone (341) 206-8344

16977 Healdsburg Ave
Healdsburg, CA 95448

1144 65th St
Ste F
Oakland, CA 94608
Phone (510) 919-1400

9800 Glen Center Dr
San Diego, CA 92131
Phone (858) 832-2500

1444 McAllister St
San Francisco, CA 94115
Phone (415) 305-4002

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21048/brand/1/csg/1/fhir/r4
  • Direct secure messaging: mgenualdi@landmarkhealth-direct.org
  • Direct secure messaging: michael.genualdi@299395540647940.direct.elationemr.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1460073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719532800000",
    "number": "1124482823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 511250",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900517805",
            "telephone_number": "510-929-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 4TH ST STE 201",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947101986",
            "telephone_number": "510-929-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENUALDI",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-08",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A151396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.