Imhotep Issaquena Medical Group

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

G33795 Issued in CA

Legal business name

IMHOTEP ISSAQUENA MEDICAL GROUP

Practice address

401 29TH St
#206
Oakland, CA 94609-3519

Phone

(510) 231-0955

Fax

(510) 231-0482

NPI assigned

Mar 15, 2007

Organization subpart

No

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

Authorized official

Name

Otis Eugene Rounds, MDNPI 1376741983

Title

President

Phone

(510) 231-0955

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Otis Eugene Rounds, MD

  • Hospitalist Physician
  • San Pablo, CA
  • NPI 1376741983
  NPD (past) Authorized official
• Clifford Ralph Melton, MD MD

  • Urology Physician
  • Oakland, CA
  • NPI 1124114947
  NPD (past)

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1659405165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2023 VALE RD",
            "address_2": "#211",
            "city": "SAN PABLO",
            "state": "CA",
            "postal_code": "948063834",
            "telephone_number": "510-231-0955",
            "fax_number": "510-231-0482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 29TH ST",
            "address_2": "#206",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093519",
            "telephone_number": "510-231-0955",
            "fax_number": "510-231-0482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMHOTEP ISSAQUENA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "ROUNDS",
        "authorized_official_first_name": "OTIS",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-231-0955",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "G33795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G37795",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dina Mireya Ilijic Manzanera, RDH
• Melissa Ann Im-Giuffrida, FNP-C
• Taylor Miyuki Imai, DO
• Kento Imajo
• Akili Imara
• Samantha Imperatrice, CMT
• Improving Habits
• Ruth Imru, NP
• Suon R In
• Michelle Ina

• Primary Care Clinic/Center in Oakland, CA
• Providers in Oakland, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.