Organization Active NPI

Gastroenterology Specialists Medical Group, Inc a Medical Corporation

  • Gastroenterology Physician
  • Castro Valley, CA
National Provider Identifier
1629170998
Registry record updated Aug 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
GASTROENTEROLOGY SPECIALISTS MEDICAL GROUP, INC A MEDICAL CORPORATION
Practice address
19845 Lake Chabot Rd
Suite 104
Castro Valley, CA 94546-4055
Phone
(510) 537-4415
NPI assigned
Sep 5, 2006
Last updated
Aug 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2022

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

Authorized official

Name
Dr. Wei-Fang Ko Ko, M.D.
Title
President
Phone
(510) 537-4415

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

19845 Lake Chabot Rd
Suite 104
Castro Valley, CA 94546-4055

Mailing address

19845 Lake Chabot Rd
Suite 104
Castro Valley, CA 94546-4055
Phone (510) 537-4415

Other names 1

  • GASTROENTEROLOGY SPECIALISTS 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
O20040310000752 CA Part B Supplier - Clinic/Group Practice 5193613008 Receives reassigned benefits from 8 practitioners
Practice locations: Castro Valley, CA; San Leandro, CA; Hayward, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2315838Gastroenterology Specialists Medical Group19845 Lake Chabot Ste 104, Castro Valley, CA 94546ComplianceNov 19, 2027

National Provider Directory

National Provider Directory

Locations

27206 Calaroga Ave
Ste 212
Hayward, CA 94545
Phone (510) 887-1777

Practitioners & affiliated clinicians

Practitioners 10

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": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659312000000",
    "number": "1629170998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19845 LAKE CHABOT RD",
            "address_2": "SUITE 104",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945464055",
            "telephone_number": "510-537-4415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19845 LAKE CHABOT RD",
            "address_2": "SUITE 104",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945464055",
            "telephone_number": "510-537-4415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROENTEROLOGY SPECIALISTS MEDICAL GROUP, INC A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A",
        "authorized_official_last_name": "KO",
        "authorized_official_first_name": "WEI-FANG KO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-537-4415",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GASTROENTEROLOGY SPECIALISTS MEDICAL GROUP",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "GASTROENTEROLOGY SPECIALISTS MEDICAL GROUP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Castro Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.