Individual provider Active NPI

Breanna Tetreault, DO

  • Family Medicine Physician
  • Berkeley, CA
National Provider Identifier
1164085536
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A20241 Issued in CA
Practice address
3100 San Pablo Ave Ste 310
Berkeley, CA 94702-2498
Phone
(510) 985-5000
Fax
(510) 985-5002
NPI assigned
Apr 20, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A20241 CA Primary

Addresses

Primary practice location

3100 San Pablo Ave Ste 310
Berkeley, CA 94702-2498

Mailing address

1450 Treat Blvd Ste 300
Walnut Creek, CA 94597-2168
Phone (925) 952-2828

Other practice location 1

3569 Round Barn Cir Ste 200
Santa Rosa, CA 95403-5781
Phone (707) 583-8800

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
I20221006002295 CA Practitioner - Family Practice 8426434903 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
John Muir Physician NetworkGroup PAC ID 6608789813, 488 clinicians

Practice addresses (Care Compare)

350 John Muir Pkwy
Suite 250
Brentwood, CA 94513-5194
Phone (925) 308-8160

Hospital & facility affiliations

  • Healthflex Home Health Services Home health agency, Oakland, CA, CCN 059551
  • John Muir Medical Center - Walnut Creek Campus Hospital, Walnut Creek, CA, CCN 050180
  • Alta Bates Summit Medical Center - Alta Bates Camp Hospital, Berkeley, CA, CCN 050305
  • UCSF Medical Center Hospital, San Francisco, CA, CCN 050454
  • Alta Bates Summit Medical Center Hospital, Oakland, CA, CCN 050043
  • John Muir Medical Center - Concord Campus Hospital, Concord, CA, CCN 050496

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
John Muir Physician Network CurrentSince Oct 3, 2022 Accepting new patients
John Muir Health Past Accepting new patients

Locations

3100 San Pablo Ave
Ste 310
Berkeley, CA 94702
Phone (510) 985-5020

350 John Muir Pkwy
Ste 250
Brentwood, CA 94513
Phone (925) 308-8111

2400 Balfour Rd
Ste 120
Brentwood, CA 94513
Phone (925) 308-8112

1450 Treat Blvd
Ste 300
Walnut Creek, CA 94597

Interoperability endpoints

  • Direct secure messaging: btetreault121821@ehr.johnmuirhealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 6

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": "1555718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663804800000",
    "number": "1164085536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 TREAT BLVD STE 300",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945972168",
            "telephone_number": "925-952-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SAN PABLO AVE STE 310",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947022498",
            "telephone_number": "510-985-5000",
            "fax_number": "510-985-5002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3569 Round Barn Cir Ste 200",
            "address_purpose": "LOCATION",
            "city": "Santa Rosa",
            "state": "CA",
            "postal_code": "954035781",
            "country_code": "US",
            "telephone_number": "707-583-8800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TETREAULT",
        "first_name": "BREANNA",
        "name_prefix": "Mrs.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-20",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A20241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.