NPIMap

Organization Active NPI

Bay Area Retina Associates, Medical Group

  • Retina Specialist (Ophthalmology) Physician
  • Vallejo, CA
National Provider Identifier
1790928067
Registry record updated May 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
BAY AREA RETINA ASSOCIATES, MEDICAL GROUP
Practice address
1460 N Camino Alto Ste 206
Vallejo, CA 94589-2567
Phone
(707) 552-9596
Fax
(707) 552-9599
NPI assigned
Apr 15, 2009
Organization subpart
Yes
Parent organization
BAY AREA RETINA ASSOCIATES, MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 23, 2021

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

Authorized official

Name
Agnes Mercado, CRCS
Title
Director of Revenue Cycle
Phone
(925) 265-8324

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207WX0107X Primary

Addresses

Primary practice location

1460 N Camino Alto Ste 206
Vallejo, CA 94589-2567

Mailing address

365 Lennon LN Ste 250
Walnut Creek, CA 94598-5915
Phone (925) 265-8324

Other identifiers 2

IdentifierTypeStateIssuer
GR0030671MedicaidCA
GR0030670MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Bay Area Retina Associa4 organizations share this tax ID, including this one
Part of
Bay Area Retina Associa

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1239753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621728000000",
    "number": "1790928067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 LENNON LN STE 250",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945985915",
            "telephone_number": "925-265-8324",
            "fax_number": "925-522-8658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 N CAMINO ALTO STE 206",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892567",
            "telephone_number": "707-552-9596",
            "fax_number": "707-552-9599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY AREA RETINA ASSOCIATES, MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAY AREA RETINA ASSOCIATES, MEDICAL GROUP",
        "enumeration_date": "2009-04-15",
        "last_updated": "2021-05-23",
        "certification_date": "2021-05-23",
        "status": "A",
        "authorized_official_last_name": "MERCADO",
        "authorized_official_first_name": "AGNES",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "925-265-8324",
        "authorized_official_credential": "CRCS"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030671",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030670",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vallejo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2021; 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.