Individual provider Active NPI

Marietta Smith, MD

  • Anesthesiology Physician
  • Oakland, CA
National Provider Identifier
1619401916
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A159329 Issued in CA
Practice address
350 Hawthorne Ave
Oakland, CA 94609-3108
Phone
(510) 655-4000
NPI assigned
Apr 13, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Anesthesiology Physician 207L00000X A159329 CA Primary

Addresses

Primary practice location

350 Hawthorne Ave
Oakland, CA 94609-3108

Mailing address

2001 Addison St Ste 329
Berkeley, CA 94704-1192

Other practice location 1

2351 Clay St
Suite 380
San Francisco, CA 94115-1931
Phone (415) 600-6000

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
I20220914001141 CA Practitioner - Anesthesiology 2769867621 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Geisel School of Medicine at Dartmouth, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Bay Anesthesiology Medical Group IncGroup PAC ID 2365348950, 42 clinicians

Practice addresses (Care Compare)

2450 Ashby Ave
Berkeley, CA 94705-2067
Phone (510) 204-4000

Hospital & facility affiliations

  • Alta Bates Summit Medical Center Hospital, Oakland, CA, CCN 050043
  • Alta Bates Summit Medical Center - Alta Bates Camp Hospital, Berkeley, CA, CCN 050305

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A159329CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Bay Anesthesiology Medical Group, Inc Anesthesiology CurrentSince Aug 15, 2022 Accepting new patients

Locations

2450 Ashby Ave
Berkeley, CA 94705
Phone (510) 204-1566

2001 Addison St
Ste 329
Berkeley, CA 94704
Phone (510) 666-0854

350 Hawthorne Ave
Oakland, CA 94609
Phone (510) 655-4000

Interoperability endpoints

  • Direct secure messaging: msmith302288@hisp.ehr.sutterhealth.org

Organizations & group practices 1

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 2

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": "1492041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1619401916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 ADDISON ST STE 329",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947041192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 HAWTHORNE AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093108",
            "telephone_number": "510-655-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2351 Clay St",
            "address_2": "Suite 380",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941151931",
            "country_code": "US",
            "telephone_number": "415-600-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARIETTA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-13",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A159329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.