NPIMap

Organization Active NPI

North Bay Eye Associates, a Medical Corporation

Doing business as North Baye Eye Association, Inc

  • Ophthalmology Physician
  • Sonoma, CA
National Provider Identifier
1710163324
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
NORTH BAY EYE ASSOCIATES, A MEDICAL CORPORATION
Doing business as
North Baye Eye Association, Inc
Practice address
545 3Rd St W
Sonoma, CA 95476-6501
Phone
(707) 996-1052
Fax
(707) 996-6787
NPI assigned
Jan 14, 2008
Organization subpart
Yes
Parent organization
NORTH BAY EYE ASSOCIATES, A MEDICAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Kimberlee K Breslin
Title
Accounts Receivable Manager
Phone
(707) 588-7946

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X CA Primary
Durable Medical Equipment & Medical Supplies 332B00000X CA

Addresses

Primary practice location

545 3Rd St W
Sonoma, CA 95476-6501

Mailing address

PO Box 11688
Santa Rosa, CA 95406-1688
Phone (707) 996-1052

Other names 1

  • North Baye Eye Association, Inc Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050414000990 CA Part B Supplier - Clinic/Group Practice 9436147980 Receives reassigned benefits from 14 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Petaluma, CA; Sonoma, CA; Santa Rosa, CA; Healdsburg, CA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
North Bay Eye Care Partnership Inc

Locations

545 3rd St W
Sonoma, CA 95476
Phone (707) 996-1052

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

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": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1710163324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11688",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954061688",
            "telephone_number": "707-996-1052",
            "fax_number": "707-996-6787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 3RD ST W",
            "city": "SONOMA",
            "state": "CA",
            "postal_code": "954766501",
            "telephone_number": "707-996-1052",
            "fax_number": "707-996-6787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH BAY EYE ASSOCIATES, A MEDICAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH BAY EYE ASSOCIATES, A MEDICAL CORPORATION",
        "enumeration_date": "2008-01-14",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BRESLIN",
        "authorized_official_first_name": "KIMBERLEE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ACCOUNTS RECEIVABLE MANAGER",
        "authorized_official_telephone_number": "707-588-7946"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Baye Eye Association, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sonoma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.