NPIMap

Organization Active NPI

Primary Pediatric Medical Group Inc.

  • Pediatrics Physician
  • Oakland, CA
National Provider Identifier
1902903180
Registry record updated Feb 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PRIMARY PEDIATRIC MEDICAL GROUP INC.
Practice address
3300 Webster St
Suite 1202
Oakland, CA 94609-3117
Phone
(510) 433-1040
Fax
(510) 433-1043
NPI assigned
Sep 20, 2006
Last updated
Feb 26, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2009

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

Authorized official

Name
Beverly Thompson
Title
Practice Manager
Phone
(510) 433-1040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

3300 Webster St
Suite 1202
Oakland, CA 94609-3117

Mailing address

PO Box 618
Novato, CA 94948-0618
Phone (510) 433-1040

National Provider Directory

National Provider Directory

Locations

3300 Webster St
Ste 1202
Oakland, CA 94609
Phone (510) 433-1040

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235606400000",
    "number": "1902903180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 618",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949480618",
            "telephone_number": "510-433-1040",
            "fax_number": "510-433-1043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 WEBSTER ST",
            "address_2": "SUITE 1202",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093117",
            "telephone_number": "510-433-1040",
            "fax_number": "510-433-1043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY PEDIATRIC MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2009-02-26",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "510-433-1040"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "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 Feb 26, 2009; 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.