NPIMap

Organization Active NPI

East Bay Cardiac Surgery Center Medical Group

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Oakland, CA
National Provider Identifier
1609986777
Registry record updated Mar 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
EAST BAY CARDIAC SURGERY CENTER MEDICAL GROUP
Practice address
3300 Webster St
Suite 500
Oakland, CA 94609-3117
Phone
(510) 465-6600
Fax
(510) 839-0806
NPI assigned
Aug 30, 2006
Last updated
Mar 10, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2015

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

Authorized official

Name
Dr. Junaid Hameed Khan, M.D.NPI 1750493466
Title
Managing Partner
Phone
(510) 465-6600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X NU Primary

Addresses

Primary practice location

3300 Webster St
Suite 500
Oakland, CA 94609-3117

Mailing address

3300 Webster St
Suite 500
Oakland, CA 94609-3117
Phone (510) 465-6600

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ03169ZOtherCABLUE SHIELD GRP PROVIDER#
GR0060340MedicaidCA

Other names 1

  • Iverson & Stanten Cardiac & Thoracic Surgery Medical Group Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061002000562 CA Part B Supplier - Clinic/Group Practice 0244235919 Receives reassigned benefits from 10 practitioners
Practice locations: Oakland, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425945600000",
    "number": "1609986777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 WEBSTER ST",
            "address_2": "SUITE 500",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093117",
            "telephone_number": "510-465-6600",
            "fax_number": "510-839-0806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 WEBSTER ST",
            "address_2": "SUITE 500",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093117",
            "telephone_number": "510-465-6600",
            "fax_number": "510-839-0806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST BAY CARDIAC SURGERY CENTER MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2015-03-10",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "JUNAID",
        "authorized_official_middle_name": "HAMEED",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "510-465-6600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GRP PROVIDER#",
            "identifier": "ZZZ03169Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0060340",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iverson & Stanten Cardiac & Thoracic Surgery Medical Group",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Mar 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.