Chabot Urology Medical Associates, a Professional Corp.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

A49141 Issued in CA

Legal business name

CHABOT UROLOGY MEDICAL ASSOCIATES, A PROFESSIONAL CORP.

Practice address

20055 Lake Chabot Rd Ste 310
Castro Valley, CA 94546-5334

Phone

(510) 889-9166

NPI assigned

Jan 27, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Sourjya Prakash Misra, M.D.NPI 1699706366

Title

President

Phone

(510) 889-9166

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 3

• Chabot Urology Medcal Associates, A Professional Corp. Doing business as
• Chabot Urology Medical Associates , A Professional Corporation Doing business as
• Chabot Urology Medical Associates, A Professional Corp. Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

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

• Sourjya P. Misra, M.D.

  • Urology Physician
  • Castro Valley, CA
  • NPI 1699706366
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1169856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689033600000",
    "number": "1679629968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20055 LAKE CHABOT RD STE 310",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945465334",
            "telephone_number": "510-889-9166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20055 LAKE CHABOT RD STE 310",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945465334",
            "telephone_number": "510-889-9166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHABOT UROLOGY MEDICAL ASSOCIATES, A PROFESSIONAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-27",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A",
        "authorized_official_last_name": "MISRA",
        "authorized_official_first_name": "SOURJYA",
        "authorized_official_middle_name": "PRAKASH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-889-9166",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "CA",
            "license": "A49141",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "E85288",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chabot Urology Medcal Associates, A Professional Corp.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chabot Urology Medical Associates , A Professional Corporation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chabot Urology Medical Associates, A Professional Corp.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chabot Urology Medical Associates, A Professional Corp.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Damoni Badru Cato-Cain
• Richard Cederstrom Jr., D.C.
• Katherine Cellini
• Karenth Galvan Centeno
• Chabot Family Associates Inc.
• Christine Chace, PPS
• Mandeep Kaur Chadha, AUD
• Anthony Chan, M.D.
• Winnie W Chan, MD
• Kalaokalani Chandler, M.D.

• Urology Physician in Castro Valley, CA
• Providers in Castro Valley, CA by specialty
• Urology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; 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.