NPIMap

Organization Active NPI

Diablo Pulmonary Medical Group, Inc

  • Pulmonary Disease Physician
  • Concord, CA
National Provider Identifier
1265443303
Registry record updated Nov 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
DIABLO PULMONARY MEDICAL GROUP, INC
Practice address
2299 Bacon St
Suite 2
Concord, CA 94520-2045
Phone
(925) 676-2942
Fax
(925) 676-7108
NPI assigned
Aug 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2013

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

Authorized official

Name
Hiromi C Takekuma, D.O.NPI 1275544389
Title
President
Phone
(925) 676-2942

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

2299 Bacon St
Suite 2
Concord, CA 94520-2045

Mailing address

2299 Bacon St
Suite 2
Concord, CA 94520-2045
Phone (925) 676-2942

Other identifiers 2

IdentifierTypeStateIssuer
GR0064710MedicaidCA
CJ5117OtherCARAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040517001331 CA Part B Supplier - Clinic/Group Practice 0042200362 Receives reassigned benefits from 13 practitioners
Practice locations: Concord, CA

National Provider Directory

National Provider Directory

Locations

2485 High School Ave
Ste 301
Concord, CA 94520
Phone (925) 676-2942

2700 Ygnacio Valley Rd
Ste 100
Walnut Creek, CA 94598
Phone (925) 939-3050

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383264000000",
    "number": "1265443303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2299 BACON ST",
            "address_2": "SUITE 2",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945202045",
            "telephone_number": "925-676-2942",
            "fax_number": "925-676-7108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2299 BACON ST",
            "address_2": "SUITE 2",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945202045",
            "telephone_number": "925-676-2942",
            "fax_number": "925-676-7108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABLO PULMONARY MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2013-11-01",
        "status": "A",
        "authorized_official_last_name": "TAKEKUMA",
        "authorized_official_first_name": "HIROMI",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "925-676-2942",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0064710",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CJ5117",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2013; 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.