Active NPI
Dominique Paiste-Ponder
- Clinical Social Worker
- Oakland, CA
National Provider Identifier
1801497904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 85739
- Practice address
- 2828 Ford Street
Oakland, CA 94601 - Phone
- (510) 830-5749
- NPI assigned
- Nov 4, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 85739 | CA | Primary |
Addresses
Primary practice location
2828 Ford Street
Oakland, CA 94601
Mailing address
700 Adeline St
Oakland, CA 94607-2608
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8785793 | Other | CA | ASW |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 85739 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686009600000",
"number": "1801497904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 ADELINE ST",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946072608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2828 FORD STREET",
"city": "OAKLAND",
"state": "CA",
"postal_code": "94601",
"telephone_number": "510-830-5749"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAISTE-PONDER",
"first_name": "DOMINIQUE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-04",
"last_updated": "2023-06-06",
"certification_date": "2023-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "85739",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASW",
"identifier": "8785793",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}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 Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.