Bancroft Pediatric Medical Group

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

BANCROFT PEDIATRIC MEDICAL GROUP

Doing business as

Bancroft Pediatric Medical Group

Practice address

1555 Doolittle Dr. 180
San Leandro, CA 94577

Phone

(510) 483-2600

Fax

(510) 483-2605

NPI assigned

Apr 25, 2006

Last updated

Jan 6, 2016By 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

Mirian Rhew, MD

Title

Senior Partner

Phone

(510) 483-2600

Specialties & licenses 1

Addresses

Other identifiers 9

Other names 1

• Bancroft Pediatric Medical Group Doing business as

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452038400000",
    "number": "1316903461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 DOOLITTLE DR STE 180",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945772239",
            "telephone_number": "510-483-2600",
            "fax_number": "510-483-2605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 DOOLITTLE DR. 180",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "94577",
            "telephone_number": "510-483-2600",
            "fax_number": "510-483-2605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANCROFT PEDIATRIC MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2016-01-06",
        "status": "A",
        "authorized_official_last_name": "RHEW",
        "authorized_official_first_name": "MIRIAN",
        "authorized_official_title_or_position": "SENIOR PARTNER",
        "authorized_official_telephone_number": "510-483-2600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LAURA GRUNBAUM MD LICENSE",
            "identifier": "G80985",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MICHELE TAMSE",
            "identifier": "20A10768",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JUDITH MILLSTEIN LICENSE",
            "identifier": "A128385",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DARCY GRANT LICENSE",
            "identifier": "A102586",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARIA E BEAMER MD LICENSE",
            "identifier": "A40292",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LAURA DENENBERG MD LICENS",
            "identifier": "A60244",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STEVE SANTUCCI MD LICENSE",
            "identifier": "A63180",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIRIAM M RHEW MD LICENSE",
            "identifier": "A63066",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REI MASUI LICENSE",
            "identifier": "A69220",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bancroft Pediatric Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rebecca Ann Banatao, DPT
• Keilani M Banawa, DMD
• Bancroft Convalescent Hospital, Inc. (Bancroft Convalescent Hospital)
• Bancroft Dental Care
• Bancroft Health Group, Inc. (Bancroft Healthcare Center)
• Alma Fernandez Bandong, PHYSICAL THERAPIST
• Abhijan Banerjee, M.D.
• Jaepyoung Bang
• Eveline Banh
• Audrey E Banks

• Pediatrics Physician in San Leandro, CA
• Providers in San Leandro, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.