Individual provider Active NPI

Andrew B Wallach, M.D.

  • Family Medicine Physician
  • Albany, CA
National Provider Identifier
1528035979
Registry record updated Jan 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
00G41883 Issued in CA
Practice address
500 San Pablo Ave
Suite 400
Albany, CA 94706-1127
Phone
(510) 204-8130
NPI assigned
Mar 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 00G41883 CA Primary

Addresses

Primary practice location

500 San Pablo Ave
Suite 400
Albany, CA 94706-1127

Mailing address

500 San Pablo Ave
Albany, CA 94706-1103
Phone (510) 204-8130

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040511000623 CA Practitioner - Family Practice 1254320583 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical School at San Antonio, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

500 San Pablo Ave
Albany, CA 94706-1103
Phone (510) 204-8130

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
00G41883CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Aug 1, 2017 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation Family Medicine CurrentSince Aug 1, 2017 Accepting new patients
Alta Bates Summit Medical Center Past Accepting new patients

Locations

500 San Pablo Ave
Berkeley, CA 94706
Phone (510) 204-8130

2500 Milvia St
Berkeley, CA 94704
Phone (510) 204-5514

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

3687 Mt Diablo Blvd
Ste 200
Lafayette, CA 94549
Phone (510) 204-6660

12 Camino Encinas
Orinda, CA 94563
Phone (510) 204-8180

795 El Camino Real
#1112
Palo Alto, CA 94301

Interoperability endpoints

  • Direct secure messaging: awallach59480@hisp.ehr.sutterhealth.org

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516838400000",
    "number": "1528035979",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SAN PABLO AVE",
            "address_2": "SUITE 400",
            "city": "ALBANY",
            "state": "CA",
            "postal_code": "947061127",
            "telephone_number": "510-204-8130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACH",
        "first_name": "ANDREW",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-03",
        "last_updated": "2018-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "00G41883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, CA

Sources for this page

Verify at the official NPI Registry.