Active NPI
Mary Beth Canavan, CNM
- Advanced Practice Midwife
- Oakland, CA
National Provider Identifier
1326148677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- License
- NMW1440
- Practice address
- 1030 International Blvd
Oakland, CA 94606-3730 - Phone
- (510) 238-5400
- Fax
- (510) 238-5437
- NPI assigned
- Sep 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | NMW1440 | CA | Primary |
Addresses
Primary practice location
1030 International Blvd
Oakland, CA 94606-3730
Mailing address
1601 Fruitvale Ave
Oakland, CA 94601-2322
Phone (510) 535-4000
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ79046Z | Other | CA | FQHC MEDICARE PART B |
| 05-1822 | Other | CA | FQHC MEDICARE PART A |
| HAP11991F | Other | CA | FPACT |
| FHC11991F | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife, Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NMW1440 | CA | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280793600000",
"number": "1326148677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 FRUITVALE AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946012322",
"telephone_number": "510-535-4000",
"fax_number": "510-535-4128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 INTERNATIONAL BLVD",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946063730",
"telephone_number": "510-238-5400",
"fax_number": "510-238-5437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANAVAN",
"first_name": "MARY BETH",
"credential": "CNM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-25",
"last_updated": "2010-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "CA",
"license": "NMW1440",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FQHC MEDICARE PART B",
"identifier": "ZZZ79046Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FQHC MEDICARE PART A",
"identifier": "05-1822",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FPACT",
"identifier": "HAP11991F",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "FHC11991F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.