Active NPI
Cyril Bruce Callister, PA-C
- Medical Physician Assistant
- Oakland, CA
National Provider Identifier
1871518977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA20991
- Practice address
- 350 30TH St
Suite 100
Oakland, CA 94609-3424 - Phone
- (510) 204-8290
- Fax
- (510) 273-8977
- NPI assigned
- Jul 12, 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA20991 | CA | Primary |
Addresses
Primary practice location
350 30TH St
Suite 100
Oakland, CA 94609-3424
Mailing address
350 30TH St
Suite 100
Oakland, CA 94609-3424
Phone (510) 204-8290
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20991 | CA | MD | Dentist |
| PA20991 | CA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sutter East Bay Medical Foundation | Past | Accepting new patients | |
| Sutter East Bay Medical Foundation | Past | Accepting new patients |
Interoperability endpoints
- ccallister61927@hisp.ehr.sutterhealth.org
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Medical Laboratory
- Berkeley, CA
- NPI 1831381623
-
- Family Medicine Physician
- Orinda, CA
- NPI 1871538769
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317254400000",
"number": "1871518977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 30TH ST",
"address_2": "SUITE 100",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946093424",
"telephone_number": "510-204-8290",
"fax_number": "510-273-8977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 30TH ST",
"address_2": "SUITE 100",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946093424",
"telephone_number": "510-204-8290",
"fax_number": "510-273-8977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALLISTER",
"first_name": "CYRIL",
"middle_name": "BRUCE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-12",
"last_updated": "2011-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "PA20991",
"primary": true
}
],
"identifiers": [],
"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 Sep 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.