NPIMap

Individual provider Active NPI

John G Mouratoff, MD

  • Nephrology Physician
  • Berkeley, CA
National Provider Identifier
1538266218
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
G81438 Issued in CA
Practice address
2905 Telegraph Ave
Berkeley, CA 94705-2063
Phone
(510) 841-0411
Fax
(510) 845-5030
NPI assigned
Sep 17, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X G81438 CA Primary

Addresses

Primary practice location

2905 Telegraph Ave
Berkeley, CA 94705-2063

Mailing address

2905 Telegraph Ave
Berkeley, CA 94705-2063
Phone (510) 841-0411

Other identifiers 1

IdentifierTypeStateIssuer
00G81438MedicaidCA

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
I20080624000291 CA Practitioner - NephrologyPractitioner - Internal Medicine 3476560574 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Hahnemann University College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

125 Hospital Dr
Vallejo, CA 94589-2562
Phone (707) 642-7510

2905 Telegraph Ave
Berkeley, CA 94705-2017
Phone (510) 841-0411

350 30TH St
Suite 311
Oakland, CA 94609-3425
Phone (510) 625-8310

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
East Bay Nephrology Medical Group, Inc. Nephrology CurrentSince Jul 12, 1999 Accepting new patients
Dialysis Access Center a Medical Corporation Nephrology CurrentSince Feb 19, 2003 Accepting new patients
East Bay Nephrology Medical Group, Inc. Nephrology CurrentSince Jul 12, 1999 Accepting new patients
Alta Bates Summit Medical Center Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients
California Pacific Medical Group, Inc. Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
Alameda Health System Past Accepting new patients
Hill Physicians Medical Group - PPO Program Past Accepting new patients

Locations

2905 Telegraph Ave
Berkeley, CA 94705
Phone (510) 841-0411

10690 San Pablo Ave
El Cerrito, CA 94530
Phone (510) 528-9590

1411 E 31st St
Oakland, CA 94602
Phone (510) 437-4323

3012 Summit St
Oakland, CA 94609
Phone (510) 251-1002

3012 Summit St
#D
Oakland, CA 94609
Phone (510) 251-1002

3043 Summit St
Oakland, CA 94609
Phone (510) 451-6840

350 30th St
Ste 311
Oakland, CA 94609
Phone (510) 465-0941

14020 San Pablo Ave
Ste A
San Pablo, CA 94806
Phone (510) 235-1057

125 Hospital Dr
Vallejo, CA 94589
Phone (707) 642-7510

127 Hospital Dr
Ste 204
Vallejo, CA 94589
Phone (707) 642-7510

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: jmouratoff14410@alamedahs.direct-ci.com
  • Direct secure messaging: john.mouratoff.1@6134.direct.athenahealth.com
  • Direct secure messaging: john.mouratoff.d1.p72@direct.aac.nextgenshare.com

Organizations & group practices 10

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1538266218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2905 TELEGRAPH AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052063",
            "telephone_number": "510-841-0411",
            "fax_number": "510-845-5030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2905 TELEGRAPH AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052063",
            "telephone_number": "510-841-0411",
            "fax_number": "510-845-5030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOURATOFF",
        "first_name": "JOHN",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "G81438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G81438",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.