Moges Lemma Hailemariam, FNP/DNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95020486 Issued in CA

Practice address

1335 Stanford Ave
Emeryville, CA 94608-2536

Phone

(510) 647-5101

Fax

(510) 647-5105

NPI assigned

Mar 28, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• NA NA NA Other name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: moges.hailemariam@22525392.chartlogic.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pain and Rehabilitative Consultants Medical Group

  • Interventional Pain Medicine Physician
  • Emeryville, CA
  • NPI 1952466963
  Medicare reassignment NPD
• California Pacific Medical Group, Inc.

  dba Brown & Toland Medical Group

  • Multi-Specialty Clinic/Center
  • Oakland, CA
  • NPI 1275002453
  NPD (past)
• Integrated Pain Care Inc

  • Pain Medicine (Anesthesiology) Physician
  • Richmond, CA
  • NPI 1447517404
  NPD (past)

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

{
    "created_epoch": "1648425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1750031068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1335 STANFORD AVE",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946082536",
            "telephone_number": "510-647-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1335 STANFORD AVE",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946082536",
            "telephone_number": "510-647-5101",
            "fax_number": "510-647-5105"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3160 Garrity Way",
            "address_purpose": "LOCATION",
            "city": "San Pablo",
            "state": "CA",
            "postal_code": "948061983",
            "country_code": "US",
            "telephone_number": "510-758-7462",
            "fax_number": "866-509-2661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAILEMARIAM",
        "first_name": "MOGES",
        "middle_name": "LEMMA",
        "name_prefix": "Dr.",
        "credential": "FNP/DNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-28",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95020486",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL REGISTRY OF CERTIFIED MEDICAL EXAMINER",
            "identifier": "6360511283",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NA",
            "last_name": "NA",
            "middle_name": "NA",
            "credential": "NA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jennifer Lynn Landers Gullo, MD
• Sophia Guo, DMD
• Elissa Gutierrez
• Sandra Yvonne Guzman, PTA
• Anh Tran Ha
• Michael B Hajduk, MD
• Kathryn L Hall-Boyer, MD
• Rhondalyn Hall, LE
• Siddeg Hamid
• Daoud Hamidi, PA-C

• Family Nurse Practitioner in Emeryville, CA
• Providers in Emeryville, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.