Individual provider Active NPI

Tinebeta Daniel Mekonnen, PA-C

  • Physician Assistant
  • Berkeley, CA
National Provider Identifier
1720592009
Registry record updated Nov 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2762 Mathews St
Berkeley, CA 94702-2245
Phone
(619) 807-3236
NPI assigned
Nov 25, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 25, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

2762 Mathews St
Berkeley, CA 94702-2245

Mailing address

2762 Mathews St
Berkeley, CA 94702-2245
Phone (619) 807-3236

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180731004040 CA Practitioner - Physician Assistant 5991053456 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

3100 Telegraph Ave
Oakland, CA 94609-3239
Phone (510) 204-8290

3200 Kearney St
Fremont, CA 94538-2299
Phone (510) 490-1222

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Jul 9, 2018 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jul 9, 2018 Accepting new patients
Sutter East Bay Medical Foundation Past Accepting new patients

Locations

500 San Pablo Ave
Berkeley, CA 94706
Phone (510) 204-8130

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

3687 Mt Diablo Blvd
Ste 200
Lafayette, CA 94549
Phone (510) 204-6660

795 El Camino Real
#1112
Palo Alto, CA 94301

Interoperability endpoints

  • Direct secure messaging: tmekonnen407512@hisp.ehr.sutterhealth.org

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1511568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511568000000",
    "number": "1720592009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2762 MATHEWS ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947022245",
            "telephone_number": "619-807-3236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2762 MATHEWS ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947022245",
            "telephone_number": "619-807-3236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEKONNEN",
        "first_name": "TINEBETA",
        "middle_name": "DANIEL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-25",
        "last_updated": "2017-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.