NPIMap

Organization Active NPI

Timothy a Fitzer MD Inc a Professional Medical Corporation

Doing business as Berkeley Family Practice Medical Group

  • Family Medicine Physician
  • Berkeley, CA
National Provider Identifier
1821104100
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TIMOTHY A FITZER MD INC A PROFESSIONAL MEDICAL CORPORATION
Doing business as
Berkeley Family Practice Medical Group
Practice address
2636 Telegraph Ave
Berkeley, CA 94704-3322
Phone
(510) 841-1647
Fax
(510) 848-4924
NPI assigned
Aug 21, 2006
Last updated
Dec 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Authorized official

Name
Ms. Loren Palacios
Title
Administrator
Phone
(510) 841-1647

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X CA Primary

Addresses

Primary practice location

2636 Telegraph Ave
Berkeley, CA 94704-3322

Mailing address

2636 Telegraph Ave Ste a
Berkeley, CA 94704-3373
Phone (510) 841-1647

Other names 1

  • Berkeley Family Practice Medical Group Doing business as

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
05D0942853Berkeley Family Practice2636 Telegraph Ave, Berkeley, CA 94704Certificate of waiverMar 17, 2028

National Provider Directory

National Provider Directory

Locations

2636 Telegraph Ave
Berkeley, CA 94704
Phone (510) 841-1647

2636 Telegraph Ave
Ste A
Berkeley, CA 94704
Phone (510) 841-1647

2134 Eureka Way
Redding, CA 96001
Phone (402) 486-7000

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1821104100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2636 TELEGRAPH AVE STE A",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947043373",
            "telephone_number": "510-841-1647",
            "fax_number": "510-848-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2636 TELEGRAPH AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947043322",
            "telephone_number": "510-841-1647",
            "fax_number": "510-848-4924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY A FITZER MD INC A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "PALACIOS",
        "authorized_official_first_name": "LOREN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "510-841-1647",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Berkeley Family Practice Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Berkeley Family Practice Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berkeley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.