Active NPI
Richard Joseph Kerbavaz, MD
- Surgery Physician
- Berkeley, CA
National Provider Identifier
1861428930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- G432250
- Practice address
- 2316 Dwight Way
Berkeley, CA 94704 - Phone
- (510) 845-4500
- Fax
- (510) 845-0360
- NPI assigned
- Jun 23, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | G432250 | CA | Primary |
Addresses
Primary practice location
2316 Dwight Way
Berkeley, CA 94704
Mailing address
2316 Dwight Way
Berkeley, CA 94704
Phone (510) 845-4500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G43225 | Other | CA | STATE LICENSE |
| 00G432250 | Medicaid | CA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G432250 | CA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413763200000",
"number": "1861428930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2316 DWIGHT WAY",
"city": "BERKELEY",
"state": "CA",
"postal_code": "94704",
"telephone_number": "510-845-4500",
"fax_number": "510-845-0360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2316 DWIGHT WAY",
"city": "BERKELEY",
"state": "CA",
"postal_code": "94704",
"telephone_number": "510-845-4500",
"fax_number": "510-845-0360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERBAVAZ",
"first_name": "RICHARD",
"middle_name": "JOSEPH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-23",
"last_updated": "2014-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "G432250",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "G43225",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G432250",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}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 Oct 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.