Individual provider Active NPI

Joanna Carr Ruthenberg, M.D.

  • Pediatrics Physician
  • Oakland, CA
National Provider Identifier
1669481214
Registry record updated Nov 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A80604 Issued in CA
Practice address
2950 International Blvd
Oakland, CA 94601-2228
Phone
(510) 535-4400
NPI assigned
Aug 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A80604 CA Primary

Addresses

Primary practice location

2950 International Blvd
Oakland, CA 94601-2228

Mailing address

3100 Telegraph Ave Ste 2103
Oakland, CA 94609-3210
Phone (510) 452-5231

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
I20130213000306 CA Practitioner - Pediatric Medicine 1759535065 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
80604CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
LPCH Medical Group Div of Lucile Pediatrics CurrentSince Jan 1, 2013 Accepting new patients
Lucile Salter Packard Children'S Hospital at Stanford Past Accepting new patients
Good Samaritan Hospital, L.P. Past Accepting new patients
Bayside Medical Group, Inc Pediatrics Past Accepting new patients

Locations

3100 Telegraph Ave
Ste 2103
Oakland, CA 94609
Phone (510) 452-5231

725 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8979

1776 Ygnacio Valley Rd
Ste 100
Walnut Creek, CA 94598
Phone (925) 933-4383

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353369600000",
    "number": "1669481214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 TELEGRAPH AVE STE 2103",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093210",
            "telephone_number": "510-452-5231",
            "fax_number": "510-869-6679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 INTERNATIONAL BLVD",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946012228",
            "telephone_number": "510-535-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTHENBERG",
        "first_name": "JOANNA",
        "middle_name": "CARR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2012-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A80604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.