Individual provider Active NPI

Jacob A Rosenberg, MD

  • Pain Medicine Physician
  • Walnut Creek, CA
National Provider Identifier
1275537870
Registry record updated Aug 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
C41230 Issued in CA
Practice address
450 N Wiget LN
Walnut Creek, CA 94598-2408
Phone
(925) 691-9806
Fax
(925) 691-9807
NPI assigned
Jun 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine Physician 208VP0000X C41230 CA Primary

Addresses

Primary practice location

450 N Wiget LN
Walnut Creek, CA 94598-2408

Mailing address

450 N Wiget LN
Walnut Creek, CA 94598-2408
Phone (925) 691-9806

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050804001184 CA Practitioner - Pain ManagementPractitioner - Anesthesiology 4981697919 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C41230CAMDPain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
California Pacific Medical Group, Inc. Past Accepting new patients
Sutter East Bay Medical Foundation Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249516800000",
    "number": "1275537870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 N WIGET LN",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945982408",
            "telephone_number": "925-691-9806",
            "fax_number": "925-691-9807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 N WIGET LN",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945982408",
            "telephone_number": "925-691-9806",
            "fax_number": "925-691-9807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENBERG",
        "first_name": "JACOB",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-10",
        "last_updated": "2009-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "CA",
            "license": "C41230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.