Otis Perry Max Ingersoll, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

14774 Issued in CA

Practice address

500 San Pablo Ave
Albany, CA 94706-1103

Phone

(510) 204-8130

Fax

(510) 524-0861

NPI assigned

Aug 31, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Otis Perry Max Ingersoll Professional name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mingersollfnp33072@hisp.ehr.sutterhealth.org

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.

• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1023063542
  Medicare reassignment NPD
• Sutter Bay Medical Foundation

  dba Palo Alto Medial Foundation

  • Multi-Specialty Clinic/Center
  • Palo Alto, CA
  • NPI 1013950807
  Medicare reassignment NPD
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Concord, CA
  • NPI 1538180807
  NPD
• Cep America-California

  • Emergency Medicine Physician
  • Murrieta, CA
  • NPI 1588552848
  NPD
• Sutter Bay Medical Foundation

  dba Sutter Pacific Medical Foundation

  • Multi-Specialty Clinic/Center
  • Sacramento, CA
  • NPI 1003267196
  NPD
• Sutter Bay Medical Foundation

  dba Palo Alto Medical Foundation

  • Clinical Medical Laboratory
  • Santa Clara, CA
  • NPI 1669287033
  NPD

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

{
    "created_epoch": "1188518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1386838407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SAN PABLO AVE",
            "city": "ALBANY",
            "state": "CA",
            "postal_code": "947061103",
            "telephone_number": "510-204-8130",
            "fax_number": "510-524-0861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SAN PABLO AVE",
            "city": "ALBANY",
            "state": "CA",
            "postal_code": "947061103",
            "telephone_number": "510-204-8130",
            "fax_number": "510-524-0861"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2850 Telegraph Ave",
            "address_2": "#130",
            "address_purpose": "LOCATION",
            "city": "Berkeley",
            "state": "CA",
            "postal_code": "947051192",
            "country_code": "US",
            "telephone_number": "510-204-8110",
            "fax_number": "510-843-0804",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "INGERSOLL",
        "first_name": "OTIS PERRY",
        "middle_name": "MAX",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-31",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "14774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OTIS",
            "last_name": "INGERSOLL",
            "middle_name": "PERRY MAX",
            "credential": "FNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kun Huang, MD. PH.D.
• Rong Huang, MD
• Mariflorence M Hudson
• Taylor Rae Huntenburg
• Eric Husby-Gerry, DC
• Innate Chiropractic
• Daniel Peixoto Irby, MD
• Meredith Isaksen, AMFT 151125
• Island Sisters Care Foundation
• Shadan Jabali, DMD

• Family Nurse Practitioner in Albany, CA
• Providers in Albany, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.