Active NPI
Susana Judith Praver, PAC
- Medical Physician Assistant
- Oakland, CA
National Provider Identifier
1255434452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA10842
- Practice address
- 3451 E 12TH St
Oakland, CA 94601 - Phone
- (510) 535-3317
- Fax
- (510) 535-4248
- NPI assigned
- Sep 6, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA10842 | CA | Primary |
Addresses
Primary practice location
3451 E 12TH St
Oakland, CA 94601
Mailing address
1601 Fruitvale Ave
Oakland, CA 94601-2322
Phone (510) 535-4000
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HAP72021F | Other | CA | FPACT |
| FHC71021F | Medicaid | CA | |
| 55-1975 | Other | CA | FQHC MEDICARE PART A |
| ZZZ29799Z | Other | CA | FQHC MEDICARE PART B |
Other names 1
- Shoshana Judith Praver
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- spraver306302@direct.ochin.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788652800000",
"number": "1255434452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 FRUITVALE AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946012322",
"telephone_number": "510-535-4000",
"fax_number": "510-535-4128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3451 E 12TH ST",
"city": "OAKLAND",
"state": "CA",
"postal_code": "94601",
"telephone_number": "510-535-3317",
"fax_number": "510-535-4248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRAVER",
"first_name": "SUSANA",
"middle_name": "JUDITH",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-06",
"last_updated": "2026-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "PA10842",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FPACT",
"identifier": "HAP72021F",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "FHC71021F",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FQHC MEDICARE PART A",
"identifier": "55-1975",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FQHC MEDICARE PART B",
"identifier": "ZZZ29799Z",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SHOSHANA",
"last_name": "PRAVER",
"middle_name": "JUDITH",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.