NPIMap

Organization Active NPI

Pine Park Health, Inc

  • Internal Medicine Physician
  • Berkeley, CA
National Provider Identifier
1346879848
Registry record updated Sep 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 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
Last updated
Sep 2, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2026

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

Authorized official

Name
Ariel Cable
Title
Credentialing Manager
Phone
(480) 475-6531

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Acute Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2100X
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Gerontology Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LG0600X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 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

9800 Glen Center Dr
San Diego, CA 92131-1686
Phone (858) 832-2500

Other practice location 2

501 Via Casitas
Greenbrae, CA 94904-1901
Phone (510) 929-1400

Other practice location 3

2645 E Southern Ave
Tempe, AZ 85282-7649
Phone (623) 624-8280

Other practice location 4

19303 N New Tradition Rd
Sun City West, AZ 85375-3806
Phone (623) 624-8280

Other practice location 5

4500 Gilbert St
Oakland, CA 94611-4657
Phone (510) 929-1400

Other practice location 6

16977 Healdsburg Ave
Healdsburg, CA 95448-3261
Phone (510) 929-1400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2269060Pine Park Health19303 N New Tradition Rd, Sun City West, AZ 85375Certificate of waiverSep 19, 2026

National Provider Directory

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

3850 Walnut Ave
Fremont, CA 94538
Phone (341) 206-8344

16977 Healdsburg Ave
Healdsburg, CA 95448

5740 Lake Murray Blvd
La Mesa, CA 91942
Phone (619) 461-9014

1144 65th St
Oakland, CA 94608

1144 65th St
Ste F
Oakland, CA 94608
Phone (510) 919-1400

3121 Fruitvale Ave
Oakland, CA 94602
Phone (214) 704-2794

9800 Glen Center Dr
San Diego, CA 92131
Phone (858) 832-2500

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21048/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 28

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.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788307200000",
    "number": "1346879848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 511250",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900517805",
            "telephone_number": "510-929-1400",
            "fax_number": "510-929-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 4TH ST STE 201",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947101986",
            "telephone_number": "510-929-1400",
            "fax_number": "510-929-1414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9800 Glen Center Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921311686",
            "country_code": "US",
            "telephone_number": "858-832-2500",
            "fax_number": "858-400-3023",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "501 Via Casitas",
            "address_purpose": "LOCATION",
            "city": "Greenbrae",
            "state": "CA",
            "postal_code": "949041901",
            "country_code": "US",
            "telephone_number": "510-929-1400",
            "fax_number": "510-929-1414",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2645 E Southern Ave",
            "address_purpose": "LOCATION",
            "city": "Tempe",
            "state": "AZ",
            "postal_code": "852827649",
            "country_code": "US",
            "telephone_number": "623-624-8280",
            "fax_number": "602-835-0192",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "19303 N New Tradition Rd",
            "address_purpose": "LOCATION",
            "city": "Sun City West",
            "state": "AZ",
            "postal_code": "853753806",
            "country_code": "US",
            "telephone_number": "623-624-8280",
            "fax_number": "602-835-0192",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4500 Gilbert St",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946114657",
            "country_code": "US",
            "telephone_number": "510-929-1400",
            "fax_number": "510-929-1414",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16977 Healdsburg Ave",
            "address_purpose": "LOCATION",
            "city": "Healdsburg",
            "state": "CA",
            "postal_code": "954483261",
            "country_code": "US",
            "telephone_number": "510-929-1400",
            "fax_number": "510-929-1414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PINE PARK HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-06",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A",
        "authorized_official_last_name": "CABLE",
        "authorized_official_first_name": "ARIEL",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "480-475-6531"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.