Active NPI
Noha Mandouh Aboelata, MD
- Family Medicine Physician
- Oakland, CA
National Provider Identifier
1447246293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- A71602
- Practice address
- 419 30TH St
Suite D
Oakland, CA 94609-3301 - Phone
- (510) 451-4747
- Fax
- (510) 451-0570
- NPI assigned
- Sep 26, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
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.
-
- Health Service Clinic/Center
- Oakland, CA
- NPI 1295062164
-
- Primary Care Clinic/Center
- Oakland, CA
- NPI 1851785307
-
- General Practice Physician
- Woodland Hills, CA
- NPI 1659357341
-
- Primary Care Clinic/Center
- San Jose, CA
- NPI 1083145122
-
- Primary Care Clinic/Center
- Oakland, CA
- NPI 1932663853
Medicare participation
Medicare enrollment files- 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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040312001306 | CA | Practitioner - Family Practice | 9739078122 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A71602 | CA | MD | Family Medicine Physician |
Practice roles (7 of 8)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roots Community Health Center | Past | Accepting new patients | |
| Roots Community Health Center | Family Medicine | Past | Accepting new patients |
| California Care Level Management Direct Medical Group, Inc | Past | Accepting new patients | |
| Roots Community Health Center | Family Medicine | Past | Accepting new patients |
| Roots Community Health Center | Past | Accepting new patients | |
| Roots Community Health Center | Past | Accepting new patients | |
| Isis Health Center, Inc | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A71602 | CA | Primary |
Addresses
Primary practice location
419 30TH St
Suite D
Oakland, CA 94609-3301
Mailing address
419 30TH St
Suite D
Oakland, CA 94609-3301
Phone (510) 451-4747
NPI Registry JSON
{
"created_epoch": "1127692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1447246293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "419 30TH ST",
"address_2": "SUITE D",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946093301",
"telephone_number": "510-451-4747",
"fax_number": "510-451-0570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "419 30TH ST",
"address_2": "SUITE D",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946093301",
"telephone_number": "510-451-4747",
"fax_number": "510-451-0570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ABOELATA",
"first_name": "NOHA",
"middle_name": "MANDOUH",
"name_prefix": "Ms.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A71602",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.