David William Modersbach

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

04011994 Issued in CA

Practice address

1404 Franklin St Ste 200
Oakland, CA 94612-3208

Phone

(510) 891-8916

Fax

(510) 273-3802

NPI assigned

Jul 10, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• County of Alameda

  • Federally Qualified Health Center (FQHC)
  • Oakland, CA
  • NPI 1881632867
  NPD Authorized official

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704240000000",
    "number": "1194403048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2265 COURTLAND AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946014707",
            "telephone_number": "510-535-9122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 FRANKLIN ST STE 200",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946123208",
            "telephone_number": "510-891-8916",
            "fax_number": "510-273-3802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODERSBACH",
        "first_name": "DAVID",
        "middle_name": "WILLIAM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-10",
        "last_updated": "2024-01-03",
        "certification_date": "2023-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Community Health Worker",
            "state": "CA",
            "license": "04011994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Moceri
• Julia Mochizuki
• Joe Mock
• Kiana Modavi
• Jillian Joye Modawell, LCSW
• Barbara Modlinski-Haugen, OD
• Sitar Dinesh Mody, MA AMFT
• Katarzyna Modzelewska
• Aye Chan Moe
• Tammy Renee Moe

• Community Health Worker in Oakland, CA
• Providers in Oakland, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; 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.