Bay Area Comprehensive Spine and Sports Medical Group Inc

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

Legal business name

BAY AREA COMPREHENSIVE SPINE AND SPORTS MEDICAL GROUP INC

Practice address

5700 Telegraph Ave Ste 100
Oakland, CA 94609-1710

Phone

(510) 463-4700

Fax

(510) 463-4722

NPI assigned

Sep 29, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Michael Kwansup ParkNPI 1932289030

Title

President

Phone

(510) 463-4700

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Kwansup Park, MD

  • Physical Medicine & Rehabilitation Physician
  • Oakland, CA
  • NPI 1932289030
  Medicare reassignment NPD Authorized official
• Marina Bulatov, M.D.

  • Pain Medicine Physician
  • Oakland, CA
  • NPI 1932215944
  Medicare reassignment NPD
• Jin K. Kim, MD

  • Occupational Medicine Physician
  • Cupertino, CA
  • NPI 1760561401
  NPD (past)
• Timothy C Shen, MD

  • Physical Medicine & Rehabilitation Physician
  • Oakland, CA
  • NPI 1861572943
  NPD (past)
• Andrew V. Slucky, MD

  • Orthopaedic Surgery of the Spine Physician
  • Oakland, CA
  • NPI 1538247325
  NPD (past)

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570579200000",
    "number": "1205928645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 TELEGRAPH AVE STE 100",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946091710",
            "telephone_number": "510-463-4700",
            "fax_number": "510-463-4722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 TELEGRAPH AVE STE 100",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946091710",
            "telephone_number": "510-463-4700",
            "fax_number": "510-463-4722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY AREA COMPREHENSIVE SPINE AND SPORTS MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2019-10-09",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "KWANSUP",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-463-4700",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Bay Area Diabetes Prevention Program
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• Bay Area Foot Care, Inc

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Oakland, CA
• Providers in Oakland, CA by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.