Imhotep Issaquena Medical Group, Inc.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

G37795 Issued in CA

Legal business name

IMHOTEP ISSAQUENA MEDICAL GROUP, INC.

Practice address

2023 Vale Rd
Suite 211
San Pablo, CA 94806-3834

Phone

(510) 231-0955

Fax

(510) 231-0482

NPI assigned

Nov 14, 2006

Organization subpart

No

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

Authorized official

Name

Otis Eugene Rounds, MDNPI 1376741983

Title

President

Phone

(510) 231-0955

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Otis Eugene Rounds, MD

  • Hospitalist Physician
  • San Pablo, CA
  • NPI 1376741983
  NPD (past) Authorized official

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1831261270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2023 VALE RD",
            "address_2": "SUITE 211",
            "city": "SAN PABLO",
            "state": "CA",
            "postal_code": "948063834",
            "telephone_number": "510-231-0955",
            "fax_number": "510-231-0482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2023 VALE RD",
            "address_2": "SUITE 211",
            "city": "SAN PABLO",
            "state": "CA",
            "postal_code": "948063834",
            "telephone_number": "510-231-0955",
            "fax_number": "510-231-0482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMHOTEP ISSAQUENA MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "ROUNDS",
        "authorized_official_first_name": "OTIS",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-231-0955",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "G37795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G37795",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Hunnicutt
• Emily Hunter-Adamson, MD
• Sheree Nicole Hunter
• Johnson Quoc Huynh
• Ali Ignacio
• Insite Digestive Health Care
• Kathy T Insixiengmay
• Baulo Irorere, RN
• Mahsa Jaberiansari, DDS
• Felix Jackl

• Primary Care Clinic/Center in San Pablo, CA
• Providers in San Pablo, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; 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.