Individual provider Active NPI

Joel Paul Ambrosio, PA-C

  • Physician Assistant
  • Oakland, CA
National Provider Identifier
1154628105
Registry record updated Jul 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA21498 Issued in CA
Practice address
400 29TH St
Suite 501
Oakland, CA 94609-3522
Phone
(510) 268-1800
Fax
(510) 268-1803
NPI assigned
Feb 26, 2011
Last updated
Jul 7, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA21498 CA Primary

Addresses

Primary practice location

400 29TH St
Suite 501
Oakland, CA 94609-3522

Mailing address

400 29TH St
Suite 501
Oakland, CA 94609-3522
Phone (510) 268-1800

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
I20140226000955 CA Practitioner - Physician Assistant 1355571910 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northbay Health Medical FoundationGroup PAC ID 3274010871, 207 clinicians

Practice addresses (Care Compare)

1200 B Gale Wilson Blvd
Fairfield, CA 94533-3552
Phone (707) 429-3600

4500 Business Ctr Dr
Fairfield, CA 94534-6888

4520 Business Ctr Dr
Fairfield, CA 94534-6888

4520 Business Ctr Dr
Suite 200
Vacaville, CA 94534
Phone (707) 646-5500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA21498CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northbay Health Medical Foundation CurrentSince Jan 1, 2026 Accepting new patients
Northbay Healthcare Group CurrentSince Mar 9, 2015 Accepting new patients
Northbay Healthcare Group CurrentSince Mar 9, 2015 Accepting new patients

Locations

1200 B Gale Wilson Blvd
Fairfield, CA 94533
Phone (707) 429-3600

4520 Business Center Dr
Ste 180
Fairfield, CA 94534
Phone (707) 646-3555

4520 Business Center Dr
Ste 200
Fairfield, CA 94534
Phone (707) 646-3500

1000 Nut Tree Rd
Vacaville, CA 95687
Phone (707) 446-4000

1010 Nut Tree Rd
Ste 100B
Vacaville, CA 95687
Phone (707) 646-7999

101 Main St
Winters, CA 95694
Phone (530) 795-4123

Organizations & group practices 4

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 3

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": "1298678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594080000000",
    "number": "1154628105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 29TH ST",
            "address_2": "SUITE 501",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093522",
            "telephone_number": "510-268-1800",
            "fax_number": "510-268-1803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 29TH ST",
            "address_2": "SUITE 501",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093522",
            "telephone_number": "510-268-1800",
            "fax_number": "510-268-1803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBROSIO",
        "first_name": "JOEL",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-26",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA21498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.