Pine Park Health, Inc
Organization Active NPI Internal Medicine Physician · Berkeley, CA
NPI 1346879848 · NPPES record last updated Sep 2, 2026
Key facts
- NPI
- 1346879848
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- PINE PARK HEALTH, INC
- Practice address
- 1901 4TH St Ste 201
Berkeley, CA 94710-1986 - Phone
- (510) 929-1400
- Fax
- (510) 929-1414
- NPI assigned
- Apr 6, 2020
- Organization subpart
- No
Authorized official
- Name
- Ariel Cable
- Title
- Credentialing Manager
- Phone
- (480) 475-6531
Practitioners 28
-
Lauren Dewalt, AGNP
-
Ann B Ebiner, FNP
-
Laura Christine Eichinger, FNP-C
-
Amanda Marie Ilag, AGNP
-
Payam Parvinchiha, M.D.
-
Margot Schmidt, DNP
-
Taylor Semrad, FNP-BC
-
Anita G Shah, N.P.
-
Edward Robert Teare, APRN-BC
-
Melissa B. Vourlitis, D.O.
-
Randolph A Clark, M.D.
-
Queendoline Unyime Ekpo, ANP-BC
-
Emily Miller, NP
-
Melissa Vironica McDonald, FNP-C
-
Michael Feinberg, M.D.
-
Michael David Genualdi, M.D.
-
Amy Marie White, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D2269060 | Pine Park Health | Certificate of waiver | Sep 19, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200501001068 | CA | Part B Supplier - Clinic/Group Practice | 0345670527 |
Receives reassigned benefits from 22 practitioners Practice locations: Berkeley, CA |
| O20220928002530 | AZ | Part B Supplier - Clinic/Group Practice | 0345670527 |
Receives reassigned benefits from 7 practitioners Practice locations: Sun City West, AZ; Tempe, AZ |
National Provider Directory
Locations
10810 N Tatum Blvd
Ste 102612
Phoenix, AZ 85028
1901 4th St
Ste 201
Berkeley, CA 94710
Phone (469) 401-8820
11588 Via Rancho San Diego
El Cajon, CA 92019
Phone (619) 660-5718
3012 Bear Valley Pkwy S
Escondido, CA 92025
Phone (760) 735-8084
3850 Walnut Ave
Fremont, CA 94538
Phone (341) 206-8344
16977 Healdsburg Ave
Healdsburg, CA 95448
1144 65th St
Ste F
Oakland, CA 94608
Phone (510) 919-1400
1144 65th St
Oakland, CA 94608
3121 Fruitvale Ave
Oakland, CA 94602
Phone (214) 704-2794
Interoperability endpoints
- https://api.platform.athenahealth.com/21048/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Adult Medicine Physician |
207QA0505X | |||
| Geriatric Medicine (Family Medicine) Physician |
207QG0300X | |||
| Internal Medicine Physician |
207R00000X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X | |||
| Acute Care Nurse Practitioner |
363LA2100X | |||
| Adult Health Nurse Practitioner |
363LA2200X | |||
| Family Nurse Practitioner |
363LF0000X | |||
| Gerontology Nurse Practitioner |
363LG0600X | |||
| Primary Care Nurse Practitioner |
363LP2300X |
Addresses
Primary practice location
1901 4TH St Ste 201
Berkeley, CA 94710-1986
Mailing address
PO Box 511250
Los Angeles, CA 90051-7805
Phone (510) 929-1400
Other practice location 1
501 Via Casitas
Greenbrae, CA 94904-1901
Phone (510) 929-1400
Other practice location 2
2645 E Southern Ave
Tempe, AZ 85282-7649
Phone (623) 624-8280
Other practice location 3
9800 Glen Center Dr
San Diego, CA 92131-1686
Phone (858) 832-2500
Other practice location 4
19303 N New Tradition Rd
Sun City West, AZ 85375-3806
Phone (623) 624-8280
Other practice location 5
16977 Healdsburg Ave
Healdsburg, CA 95448-3261
Phone (510) 929-1400
Other practice location 6
4500 Gilbert St
Oakland, CA 94611-4657
Phone (510) 929-1400
Other providers in Berkeley, CA
- Jennifer Nichole Pierce
- Kathleen Suzanne Pierce
- Bianca Pierre
- Eric Pierson
- Neslihan Pinar
- Zachary Pine
- Joseph Daniel Pinizzotto
- Jayne Elizabeth Pinsky
- Corina Michelle Pintor
- Tiffany Pippen
All providers in Berkeley, CA · Internal Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.