NPIMap

Organization Active NPI

East Bay Nephrology Medical Group, Inc.

  • Nephrology Physician
  • Vallejo, CA
National Provider Identifier
1184719809
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
EAST BAY NEPHROLOGY MEDICAL GROUP, INC.
Practice address
125 Hospital Dr
Vallejo, CA 94589-2562
Phone
(510) 841-4525
Fax
(510) 848-9970
NPI assigned
Oct 4, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Thomas A Turner
Title
Chief Operating Officer
Phone
(510) 841-0411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X NU Primary

Addresses

Primary practice location

125 Hospital Dr
Vallejo, CA 94589-2562

Mailing address

2905 Telegraph Ave
Berkeley, CA 94705-2063
Phone (510) 841-0411

Other identifiers 2

IdentifierTypeStateIssuer
CR0683OtherCARAILROAD MEDICARE GROUP #
GR0049641MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040423001160 CA Part B Supplier - Clinic/Group Practice 1759377757 Receives reassigned benefits from 49 practitioners
3 other NPIs on this enrollment
Practice locations: Vallejo, CA; San Pablo, CA; Napa, CA; Oakland, CA; Lakeport, CA; Clearlake, CA; Berkeley, CA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0701826East Bay Nephrology Medical Group Inc125 Hospital Drive, Vallejo, CA 94589Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

3443 Villa Ln
Ste 6
Napa, CA 94558
Phone (707) 252-8407

127 Hospital Dr
Ste 204
Vallejo, CA 94589
Phone (707) 642-7510

Practitioners & affiliated clinicians

Practitioners 54

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1184719809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2905 TELEGRAPH AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052063",
            "telephone_number": "510-841-0411",
            "fax_number": "510-845-5030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 HOSPITAL DR",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892562",
            "telephone_number": "510-841-4525",
            "fax_number": "510-848-9970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST BAY NEPHROLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "TURNER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "510-841-0411",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP #",
            "identifier": "CR0683",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0049641",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vallejo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.