East Bay Family Practice Medical Group Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EAST BAY FAMILY PRACTICE MEDICAL GROUP INC

Practice address

3100 Telegraph Ave
Ste 2109
Oakland, CA 94609-3210

Phone

(510) 645-9900

Fax

(510) 645-9919

NPI assigned

Aug 16, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Audrey D'Andrea, MD

Title

Vice President Share Holder

Phone

(510) 645-9900

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Polly T Young, MD

  • Family Medicine Physician
  • Oakland, CA
  • NPI 1245222744

  Family Medicine

  NPD

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154313237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 TELEGRAPH AVE",
            "address_2": "STE 2109",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093210",
            "telephone_number": "510-645-9900",
            "fax_number": "510-645-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 TELEGRAPH AVE",
            "address_2": "STE 2109",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093210",
            "telephone_number": "510-645-9900",
            "fax_number": "510-645-9919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST BAY FAMILY PRACTICE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "D'ANDREA",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_title_or_position": "VICE PRESIDENT SHARE HOLDER",
        "authorized_official_telephone_number": "510-645-9900",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0003490",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Bay Community Recovery Project
• East Bay Community Recovery Project
• East Bay Community Recovery Project
• East Bay Doula Sisters
• East Bay Endosurgery Center Inc
• East Bay Gastroenterology Medical Group, Inc.
• East Bay Nephrology Medical Group, Inc
• East Bay Newborn Specialists, Inc.
• East Bay Ophthalmic Anesthesia Inc
• East Bay Orthopaedic Specialists Medical Corporation

• Family Medicine Physician in Oakland, CA
• Providers in Oakland, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.