Organization Active NPI

Diablo Neurosurgical Medical Group, Inc.

  • Neurological Surgery Physician
  • Walnut Creek, CA
National Provider Identifier
1265445993
Registry record updated Jan 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
DIABLO NEUROSURGICAL MEDICAL GROUP, INC.
Practice address
122 La Casa Via Ste 222
Walnut Creek, CA 94598-3014
Phone
(925) 937-0404
Fax
(925) 937-1340
NPI assigned
Aug 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2025

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

Authorized official

Name
Terence Chen, MDNPI 1720180946
Title
President
Phone
(925) 937-0404

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
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X Primary

Addresses

Primary practice location

122 La Casa Via Ste 222
Walnut Creek, CA 94598-3014

Mailing address

122 La Casa Via Ste 222
Walnut Creek, CA 94598-3014
Phone (925) 937-0404

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ72795ZOtherBLUE SHIELD OF CA
C41006OtherRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040812001125 CA Part B Supplier - Clinic/Group Practice 1759353345 Receives reassigned benefits from 2 practitioners
Practice locations: Walnut Creek, CA

National Provider Directory

National Provider Directory

Locations

2400 Balfour Rd
Ste 237
Brentwood, CA 94513
Phone (925) 516-3020

1455 Montego
Ste 200
Walnut Creek, CA 94598
Phone (925) 937-0404

122 La Casa Via
Ste 222
Walnut Creek, CA 94598
Phone (925) 937-0404

204 SE Stonemill Dr
Ste 200
Vancouver, WA 98684

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736294400000",
    "number": "1265445993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 LA CASA VIA STE 222",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945983014",
            "telephone_number": "925-937-0404",
            "fax_number": "925-937-1340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 LA CASA VIA STE 222",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945983014",
            "telephone_number": "925-937-0404",
            "fax_number": "925-937-1340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABLO NEUROSURGICAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "TERENCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "925-937-0404",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA",
            "identifier": "ZZZ72795Z",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "C41006",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; 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.