East Bay Nephrology Medical Group, Inc.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

EAST BAY NEPHROLOGY MEDICAL GROUP, INC.

Practice address

14020 San Pablo Ave
Ste a
San Pablo, CA 94806-3604

Phone

(510) 841-0411

Fax

(510) 845-5030

NPI assigned

Oct 4, 2006

Last updated

Oct 22, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Thomas A Turner

Title

Chief Operating Officer

Phone

(510) 841-0411

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• East Bay Nephrology Medical Group, Inc

  • Nephrology Physician
  • Oakland, CA
  • NPI 1265527980

  O20040423001160

  Same enrollment
• East Bay Nephrology Medical Group, Inc.

  • Nephrology Physician
  • Vallejo, CA
  • NPI 1184719809

  O20040423001160

  Same enrollment
• East Bay Nephrology Medical Group, Inc.

  • Nephrology Physician
  • Berkeley, CA
  • NPI 1871699074

  O20040423001160

  Same enrollment

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Chhaya B Patel, MS, RD

  • Renal Nutrition Registered Dietitian
  • Berkeley, CA
  • NPI 1952776791
  NPD
• Denise M Ricker, MD

  • Nephrology Physician
  • Berkeley, CA
  • NPI 1427155118
  NPD

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193011200000",
    "number": "1275628992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2905 TELEGRAPH AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052063",
            "telephone_number": "510-841-0411",
            "fax_number": "510-845-5030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14020 SAN PABLO AVE",
            "address_2": "STE A",
            "city": "SAN PABLO",
            "state": "CA",
            "postal_code": "948063604",
            "telephone_number": "510-841-0411",
            "fax_number": "510-845-5030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST BAY NEPHROLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-10-22",
        "status": "A",
        "authorized_official_last_name": "TURNER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "510-841-0411",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maya Deshe Drori, MFT
• Herb L. Dungeon Sr.
• Dva Healthcare Renal Care Inc (San Pablo Dialysis)
• Olga Franklin Eaglin
• East Bay Cardiology Medical Group
• East Bay Pulmonary Medical Group Professional Corporation
• Eastbay Hematology/Oncology Consultants, Inc
• Denise Ellison
• Steven Ellison, MSW
• John Ergino, PHARMD

• Nephrology Physician in San Pablo, CA
• Providers in San Pablo, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; 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.