NPIMap

Organization Active NPI

East Bay Retina Consultants a Medical Group, Inc.

  • Ophthalmology Physician
  • Oakland, CA
National Provider Identifier
1790965341
Registry record updated Apr 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
G57682 Issued in CA
Legal business name
EAST BAY RETINA CONSULTANTS A MEDICAL GROUP, INC.
Practice address
3300 Telegraph Ave.
Oakland, CA 94609-3028
Phone
(510) 444-1600
Fax
(510) 444-5117
NPI assigned
Nov 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2023

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

Authorized official

Name
Soon T. Lee, M.D.NPI 1952394553
Title
Corporate Vice President
Phone
(510) 444-1600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X G57682 CA Primary

Addresses

Primary practice location

3300 Telegraph Ave.
Oakland, CA 94609-3028

Mailing address

3300 Telegraph Ave.
Oakland, CA 94609-3028
Phone (510) 444-1600

Other practice location 1

1860 Mowry Ave Ste 308
Fremont, CA 94538-1730
Phone (510) 796-6500

Other practice location 2

5924 Stoneridge Dr Ste 201
Pleasanton, CA 94588-5400
Phone (925) 224-8777

Other practice location 3

5401 Norris Canyon Rd Ste 200
San Ramon, CA 94583-5406
Phone (925) 867-9000

Other practice location 4

1401 Willow Pass Rd Ste 120
Concord, CA 94520-7966
Phone (925) 680-1600

Other practice location 5

27206 Calaroga Ave Ste 214
Hayward, CA 94545-4300
Phone (510) 880-2967

Other names 1

  • East Bay Retina Consultants, Inc. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050330001058 CA Part B Supplier - Clinic/Group Practice 8224084405 Receives reassigned benefits from 7 practitioners
6 other NPIs on this enrollment
Practice locations: San Ramon, CA; Pleasanton, CA; Oakland, CA; Hayward, CA; Fremont, CA; Concord, CA; Brentwood, CA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1071572East Bay Retina Consultants, Inc3300 Telegraph Avenue, Oakland, CA 94609Certificate of waiverJul 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
East Bay Retina Consultants5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

3001 Colby St
Berkeley, CA 94705
Phone (415) 885-6640

2485 High School Ave
Ste 222
Concord, CA 94520
Phone (925) 685-3117

3300 Webster St
Ste 1100
Oakland, CA 94609
Phone (510) 444-1600

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Interoperability endpoints

  • Direct secure messaging: elit@eastbayretina.intellechartdirect.net
  • Direct secure messaging: wcarrera@eastbayretina.intellechartdirect.net
  • Direct secure messaging: dbrinton@eastbayretina.intellechartdirect.net
  • Direct secure messaging: srofagha@eastbayretina.intellechartdirect.net
  • Direct secure messaging: slee@eastbayretina.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681344000000",
    "number": "1790965341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 TELEGRAPH AVE.",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093028",
            "telephone_number": "510-444-1600",
            "fax_number": "510-444-5117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 TELEGRAPH AVE.",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093028",
            "telephone_number": "510-444-1600",
            "fax_number": "510-444-5117"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1860 Mowry Ave Ste 308",
            "address_purpose": "LOCATION",
            "city": "Fremont",
            "state": "CA",
            "postal_code": "945381730",
            "country_code": "US",
            "telephone_number": "510-796-6500",
            "fax_number": "510-796-6557",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5924 Stoneridge Dr Ste 201",
            "address_purpose": "LOCATION",
            "city": "Pleasanton",
            "state": "CA",
            "postal_code": "945885400",
            "country_code": "US",
            "telephone_number": "925-224-8777",
            "fax_number": "925-224-8779",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5401 Norris Canyon Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "San Ramon",
            "state": "CA",
            "postal_code": "945835406",
            "country_code": "US",
            "telephone_number": "925-867-9000",
            "fax_number": "925-867-3779",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1401 Willow Pass Rd Ste 120",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "CA",
            "postal_code": "945207966",
            "country_code": "US",
            "telephone_number": "925-680-1600",
            "fax_number": "925-680-1602",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "27206 Calaroga Ave Ste 214",
            "address_purpose": "LOCATION",
            "city": "Hayward",
            "state": "CA",
            "postal_code": "945454300",
            "country_code": "US",
            "telephone_number": "510-880-2967",
            "fax_number": "510-880-2634",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAST BAY RETINA CONSULTANTS A MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-13",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SOON",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "CORPORATE VICE PRESIDENT",
        "authorized_official_telephone_number": "510-444-1600",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G57682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Bay Retina Consultants, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "East Bay Retina Consultants, Inc.",
            "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 Apr 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.