Individual provider Active NPI

Berenise Gomez Vargas Gomez Vargas

  • Registered Dietitian
  • Concord, CA
National Provider Identifier
1376200311
Registry record updated Nov 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Practice address
2740 Grant St
Concord, CA 94520-2265
Phone
(925) 674-4100
NPI assigned
Nov 24, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X Primary

Addresses

Primary practice location

2740 Grant St
Concord, CA 94520-2265

Mailing address

3200 Northwood Dr Apt 311
Concord, CA 94520-4503
Phone (209) 761-4185

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211208001136 CA Practitioner - Registered Dietitian Or Nutrition Professional 1951791813 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
La Clinica de la Raza IncGroup PAC ID 1557258282, 130 clinicians

Practice addresses (Care Compare)

1501 Fruitvale Ave
Oakland, CA 94601-2322
Phone (510) 535-6200

1515 Fruitvale Ave
Oakland, CA 94601-2322
Phone (510) 535-6300

1515 Fruitvale Ave
Oakland, CA 94601-2355

3050 E 16TH St
Oakland, CA 94601-2319
Phone (510) 535-4700

3060 E 9TH St
Suite B
Oakland, CA 94601-2925
Phone (510) 535-4141

3451 E 12TH St
Oakland, CA 94601-3463
Phone (510) 535-3500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
La Clinica de la Raza Inc CurrentSince Dec 1, 2021 Accepting new patients
La Clinica de la Raza Inc Current Accepting new patients
La Clinica de la Raza Inc CurrentSince Dec 1, 2021 Accepting new patients
La Clinica de la Raza, Inc. Past Accepting new patients

Locations

3451 E 12th St
Fl 2
Oakland, CA 94601
Phone (510) 535-3319

3451 E 12th St
Oakland, CA 94601
Phone (510) 535-3319

3451 E 12th St
Fl 3
Oakland, CA 94601
Phone (510) 535-3710

210 Hospital Dr
Vallejo, CA 94589
Phone (707) 645-7316

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1637712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637712000000",
    "number": "1376200311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 NORTHWOOD DR APT 311",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945204503",
            "telephone_number": "209-761-4185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 GRANT ST",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945202265",
            "telephone_number": "925-674-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ VARGAS",
        "first_name": "BERENISE",
        "middle_name": "GOMEZ VARGAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-24",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2021; 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.