Individual provider Active NPI

Amy A. Halio, MD

  • Pediatrics Physician
  • San Lorenzo, CA
National Provider Identifier
1780699538
Registry record updated Aug 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
G57684 Issued in CA
Practice address
50 E. Lewelling Blvd
RM S-5
San Lorenzo, CA 94580-1732
Phone
(510) 317-3167
Fax
(510) 276-5483
NPI assigned
Jul 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2013

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 G57684 CA Primary

Addresses

Primary practice location

50 E. Lewelling Blvd
RM S-5
San Lorenzo, CA 94580-1732

Mailing address

P.O. Box 22210
Oakland, CA 94623-2210
Phone (510) 535-4000

Other identifiers 1

IdentifierTypeStateIssuer
HSP40611FMedicaidCA

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
I20190215002116 CA Practitioner - Pediatric Medicine 0446486187 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G57684CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
La Clinica de la Raza Inc Current Accepting new patients
La Clinica de la Raza Inc CurrentSince Nov 1, 2018 Accepting new patients
La Clinica de la Raza Inc CurrentSince Nov 1, 2018 Accepting new patients
La Clinica de la Raza, Inc. Past Accepting new patients

Locations

1515 Fruitvale Ave
Oakland, CA 94601
Phone (510) 535-6300

Organizations & group practices 5

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": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377216000000",
    "number": "1780699538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 22210",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946232210",
            "telephone_number": "510-535-4000",
            "fax_number": "510-535-4225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 E. LEWELLING BLVD",
            "address_2": "RM S-5",
            "city": "SAN LORENZO",
            "state": "CA",
            "postal_code": "945801732",
            "telephone_number": "510-317-3167",
            "fax_number": "510-276-5483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALIO",
        "first_name": "AMY",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-30",
        "last_updated": "2013-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G57684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP40611F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Lorenzo, CA

Sources for this page

Verify at the official NPI Registry.