NPIMap

Organization Active NPI

Sutter Bay Hospitals

Doing business as Alta Bates Summit Outpatient Pharmacy

  • Community/Retail Pharmacy
  • Berkeley, CA
National Provider Identifier
1326554239
Registry record updated Dec 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY52043 Issued in CA
Legal business name
SUTTER BAY HOSPITALS
Doing business as
Alta Bates Summit Outpatient Pharmacy
Sutter Health Specialty Pharmacy @ ABSMC
Practice address
2001 Dwight Way Ste 2182
Berkeley, CA 94704-2608
Phone
(510) 204-6550
Fax
(510) 204-5895
NPI assigned
Dec 15, 2017
Last updated
Dec 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
SUTTER BAY HOSPITALSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 21, 2022

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

Authorized official

Name
Michael Federico, PHARMD
Title
Director of Pharmacy
Phone
(510) 869-8452

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHY52043 CA Primary
Specialty Pharmacy 3336S0011X PHY52043 CA

Addresses

Primary practice location

2001 Dwight Way Ste 2182
Berkeley, CA 94704-2608

Mailing address

2001 Dwight Way Ste 2182
Berkeley, CA 94704-2608
Phone (510) 204-6550

Other identifiers 2

IdentifierTypeStateIssuer
PHY52043OtherCABOARD OF PHARMACY
PHY56025OtherCACA BOARD OF PHARMACY

Other names 2

  • Alta Bates Summit Outpatient Pharmacy Doing business as
  • Sutter Health Specialty Pharmacy @ ABSMC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220920002103 CA DME Supplier - Pharmacy 3476506528 Practice locations: Berkeley, CA

Other NPIs with the same Medicare PAC ID 22

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 22

National Provider Directory

National Provider Directory
Tax ID family
Childrens Hosp Pharmacy62 organizations share this tax ID, including this one
Part of
Childrens Hosp Pharmacy

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2001 Dwight Way
Ste 2182
Berkeley, CA 94704
Phone (510) 204-6550

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sutter Lakeside HospitalLakeport, CA, CCN 051329 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2010
California Pacific Medical Center - Davies CampusSan Francisco, CA, CCN 056245 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2016

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1513296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671580800000",
    "number": "1326554239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 DWIGHT WAY STE 2182",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947042608",
            "telephone_number": "510-204-6550",
            "fax_number": "510-204-5895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 DWIGHT WAY STE 2182",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947042608",
            "telephone_number": "510-204-6550",
            "fax_number": "510-204-5895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER BAY HOSPITALS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUTTER BAY HOSPITALS",
        "enumeration_date": "2017-12-15",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A",
        "authorized_official_last_name": "FEDERICO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "510-869-8452",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY52043",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "CA",
            "license": "PHY52043",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PHARMACY",
            "identifier": "PHY52043",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA BOARD OF PHARMACY",
            "identifier": "PHY56025",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alta Bates Summit Outpatient Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Alta Bates Summit Outpatient Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sutter Health Specialty Pharmacy @ ABSMC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.