NPIMap

Individual provider Active NPI

Scott R Peerenboom, D.O.

  • Internal Medicine Physician
  • Oakland, CA
National Provider Identifier
1528385002
Registry record updated Jun 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20A13678 Issued in CA
Practice address
424 28TH St
Oakland, CA 94609-3603
Phone
(510) 452-4824
Fax
(510) 465-4503
NPI assigned
Apr 23, 2010
Last updated
Jun 1, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS015304 PA
Internal Medicine Physician 207R00000X 20A13678 CA Primary

Addresses

Primary practice location

424 28TH St
Oakland, CA 94609-3603

Mailing address

424 28TH St
Oakland, CA 94609-3603
Phone (510) 452-4824

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150428001476 CA Practitioner - Internal Medicine 0244412401 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hill Health Inc a Medical CorporationGroup PAC ID 8527362037, 10 clinicians

Practice addresses (Care Compare)

3300 Webster St
Suite 1000
Oakland, CA 94609-3125
Phone (510) 271-4400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A13678CAMDInternal Medicine Physician
13678CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Hill Health Inc a Medical Corporation Internal Medicine CurrentSince Mar 1, 2016 Accepting new patients
Ephrata Community Hospital Past Accepting new patients
Solis Healthcare, LP Past Accepting new patients
Hill Physicians Medical Group - PPO Program Past Accepting new patients

Locations

3300 Webster St
Ste 1000
Oakland, CA 94609
Phone (510) 271-4400

Interoperability endpoints

  • Direct secure messaging: speerenboom15993@hpmg.direct-ci.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1271980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433116800000",
    "number": "1528385002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 28TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093603",
            "telephone_number": "510-452-4824",
            "fax_number": "510-465-4503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 28TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093603",
            "telephone_number": "510-452-4824",
            "fax_number": "510-465-4503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEERENBOOM",
        "first_name": "SCOTT",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-23",
        "last_updated": "2015-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS015304",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A13678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.