NPIMap

Organization Active NPI

Alta Bates Summit Medical Center

Doing business as East Bay AIDS Center Outpatient Pharmacy

  • Community/Retail Pharmacy
  • Oakland, CA
National Provider Identifier
1780813485
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY49947 Issued in CA
Legal business name
ALTA BATES SUMMIT MEDICAL CENTER
Doing business as
East Bay AIDS Center Outpatient Pharmacy
Practice address
3100 Summit St
Oakland, CA 94609-3412
Phone
(510) 869-8451
Fax
(510) 869-8458
NPI assigned
Jul 2, 2009
Last updated
Jan 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Authorized official

Name
Michelle So, PHARM.D.NPI 1669122248
Title
Pharmacist
Phone
(510) 869-8456

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Clinic Pharmacy 3336C0002X NU
Community/Retail Pharmacy 3336C0003X PHY49947 CA Primary
Specialty Pharmacy 3336S0011X NU

Addresses

Primary practice location

3100 Summit St
Oakland, CA 94609-3412

Mailing address

PO Box 742585
Los Angeles, CA 90074-2585
Phone (510) 869-8451

Other identifiers 2

IdentifierTypeStateIssuer
1780813485MedicaidCA
2121109OtherPK

Other names 1

  • East Bay AIDS Center Outpatient Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Alta Ip SVC GRP9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1246492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1780813485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742585",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900742585",
            "telephone_number": "510-869-8451",
            "fax_number": "510-869-8458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SUMMIT ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093412",
            "telephone_number": "510-869-8451",
            "fax_number": "510-869-8458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA BATES SUMMIT MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-02",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "SO",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "510-869-8456",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY49947",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780813485",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2121109",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Bay AIDS Center Outpatient Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "East Bay AIDS Center Outpatient Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.