Individual provider Active NPI

Rebecca Riseman

  • Nurse Practitioner
  • Emeryville, CA
National Provider Identifier
1205828704
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11812 Issued in CA
Practice address
5915 Hollis St Ste B
Emeryville, CA 94608-2066
Phone
(510) 286-8160
NPI assigned
Aug 19, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 11812 CA Primary

Addresses

Primary practice location

5915 Hollis St Ste B
Emeryville, CA 94608-2066

Mailing address

5915 Hollis St Ste B
Emeryville, CA 94608-2066
Phone (510) 286-8160

Other identifiers 1

IdentifierTypeStateIssuer
0RN5466890MedicaidCA

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
I20031218000937 CA Practitioner - Nurse Practitioner 0941107676 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Healthcare AllianceGroup PAC ID 6305748799, 334 clinicians

Practice addresses (Care Compare)

1300 Crane St
Menlo Park, CA 94025-4260
Phone (650) 498-6500

20642 John Dr
Castro Valley, CA 94546-5103
Phone (888) 924-1036

4725 1St St
Suite 100
Pleasanton, CA 94566-7366
Phone (925) 462-7060

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11812CAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
University Healthcare Alliance CurrentSince Sep 1, 2012 Accepting new patients

Locations

5915 Hollis St
Ste B
Emeryville, CA 94608
Phone (510) 525-2400

1300 Crane St
Menlo Park, CA 94025
Phone (510) 785-5000

3100 Telegraph Ave
Ste 2109
Oakland, CA 94609
Phone (510) 645-9900

4725 1st St
Ste 100
Pleasanton, CA 94566
Phone (925) 462-7060

Interoperability endpoints

  • Direct secure messaging: rriseman89029@direct.stanfordhealthcare.org

Organizations & group practices 1

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 11

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": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1205828704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5915 HOLLIS ST STE B",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946082066",
            "telephone_number": "510-286-8160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5915 HOLLIS ST STE B",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946082066",
            "telephone_number": "510-286-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RISEMAN",
        "first_name": "REBECCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-19",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "11812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0RN5466890",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Emeryville, CA

Sources for this page

Verify at the official NPI Registry.