NPIMap

Individual provider Active NPI

Andrea Sue Cervenka, MD

  • Internal Medicine Physician
  • San Jose, CA
National Provider Identifier
1609841774
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A63427 Issued in CA
Practice address
751 S Bascom Ave
Urgent Care Clinic
San Jose, CA 95128-2604
Phone
(408) 885-5249
NPI assigned
Feb 21, 2006
Sex
Female
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
Internal Medicine Physician 207R00000X A63427 CA Primary

Addresses

Primary practice location

751 S Bascom Ave
Urgent Care Clinic
San Jose, CA 95128-2604

Mailing address

751 S Bascom Ave
San Jose, CA 95128-2604
Phone (408) 885-0000

Other identifiers 1

IdentifierTypeStateIssuer
00A345270MedicaidCA

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
I20081203000578 CA Practitioner - Internal Medicine 1658432026 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of California, San Diego School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of Santa ClaraGroup PAC ID 1254244973, shared by 46 NPIs, 1,000 clinicians

Practice addresses (Care Compare)

1993 McKee Rd
San Jose, CA 95116-1406
Phone (408) 885-5000

751 S Bascom Ave
San Jose, CA 95128-2604
Phone (408) 885-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
61 of 100Reported as group
Quality
59.41
Promoting interoperability
0
Improvement activities
40
Cost
71.45

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A63427CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Santa Clara CurrentSince Dec 1, 2019 Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara CurrentSince Dec 1, 2019 Accepting new patients
County of Santa Clara CurrentSince Jul 3, 2007 Accepting new patients
County of Santa Clara Internal Medicine CurrentSince Jul 3, 2007 Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara Past Accepting new patients

Locations

7475 Camino Arroyo
Gilroy, CA 95020
Phone (408) 852-2400

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

1996 Lundy Ave
San Jose, CA 95131
Phone (408) 299-5846

500 Tully Rd
San Jose, CA 95111
Phone (408) 817-1433

750 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-2320

2400 Moorpark Ave
Ste 204
San Jose, CA 95128

1993 McKee Rd
San Jose, CA 95116
Phone (408) 254-6320

2101 Alexian Dr
San Jose, CA 95116
Phone (408) 272-6050

660 S Fair Oaks Ave
Sunnyvale, CA 94086
Phone (408) 885-7366

Interoperability endpoints

  • Direct secure messaging: acervenka10350@santaclaravalley.direct-ci.net

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

Hospital & facility affiliations 4

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": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1609841774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 S BASCOM AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282604",
            "telephone_number": "408-885-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 S BASCOM AVE",
            "address_2": "URGENT CARE CLINIC",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282604",
            "telephone_number": "408-885-5249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CERVENKA",
        "first_name": "ANDREA",
        "middle_name": "SUE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-21",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A63427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A345270",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.