Individual provider Active NPI

Laura Wedderburn, M.D.

  • Internal Medicine Physician
  • Oakland, CA
National Provider Identifier
1912981788
Registry record updated Sep 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A74957 Issued in CA
Practice address
350 30TH St Ste 100
Oakland, CA 94609-3422
Phone
(510) 204-8290
Fax
(510) 506-7725
NPI assigned
Dec 5, 2005
Last updated
Sep 10, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A74957 CA Primary

Addresses

Primary practice location

350 30TH St Ste 100
Oakland, CA 94609-3422

Mailing address

325 Distel Cir
Los Altos, CA 94022-1408
Phone (510) 204-8290

Other practice location 1

350 Hawthorne Ave Rm 2346
Oakland, CA 94609-3108
Phone (510) 869-8836

Other identifiers 2

IdentifierTypeStateIssuer
00A749570MedicaidCA
A74957OtherCASTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040304000935 CA Practitioner - Internal MedicinePractitioner - Hospitalist 6507754322 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Howard University College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

3100 Telegraph Ave
Oakland, CA 94609-3239
Phone (510) 204-8290

3200 Kearney St
Fremont, CA 94538-2299
Phone (510) 490-1222

795 El Camino Real
Palo Alto, CA 94301-2302
Phone (415) 600-1020

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Aug 1, 2017 Accepting new patients
Pacific Redwood Medical Group Inc Internal Medicine CurrentSince Dec 1, 2018 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Aug 1, 2017 Accepting new patients
Alta Bates Summit Medical Center Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients

Locations

18400 US Highway 18
Apple Valley, CA 92307
Phone (760) 810-7590

1950 University Ave
Ste 160
East Palo Alto, CA 94303
Phone (650) 317-8100

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

1189 E Herndon Ave
Ste 103
Fresno, CA 93720
Phone (559) 450-7777

325 Distel Cir
Los Altos, CA 94022
Phone (510) 204-3977

370 Distel Cir
Los Altos, CA 94022
Phone (650) 254-5200

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

101 Rowland Way
Ste 220
Novato, CA 94945
Phone (415) 878-7200

350 30th St
Ste 100
Oakland, CA 94609
Phone (510) 204-8290

350 Hawthorne Ave
Oakland, CA 94609
Phone (510) 655-4000

350 Hawthorne Ave
Rm 2346
Oakland, CA 94609
Phone (510) 655-4000

12 Camino Encinas
Orinda, CA 94563
Phone (510) 204-8180

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

795 El Camino Real
#1112
Palo Alto, CA 94301

1555 East St
Ste 200
Redding, CA 96001
Phone (530) 229-0911

151 N Sunrise Ave
Ste 1205
Roseville, CA 95661
Phone (916) 789-1505

3838 California St
Rm 410
San Francisco, CA 94118
Phone (415) 751-1847

123 S San Mateo Dr
San Mateo, CA 94401
Phone (650) 343-4200

131 Stony Cir
Ste 1600
Santa Rosa, CA 95401
Phone (707) 541-7700

3883 Airway Dr
Ste 220
Santa Rosa, CA 95403
Phone (707) 521-7750

10200 Trinity Pkwy
Ste 101
Stockton, CA 95219
Phone (209) 323-3488

275 Hospital Dr
Ukiah, CA 95482
Phone (707) 462-7900

550 S Green Valley Rd
Watsonville, CA 95076
Phone (831) 458-5865

1 Marcela Dr
Willits, CA 95490
Phone (707) 456-3001

Interoperability endpoints

  • Direct secure messaging: lwedderburn249019@hisp.ehr.sutterhealth.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631232000000",
    "number": "1912981788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 DISTEL CIR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221408",
            "telephone_number": "510-204-8290",
            "fax_number": "510-506-7725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 30TH ST STE 100",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093422",
            "telephone_number": "510-204-8290",
            "fax_number": "510-506-7725"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 Hawthorne Ave Rm 2346",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946093108",
            "country_code": "US",
            "telephone_number": "510-869-8836",
            "fax_number": "510-869-6888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEDDERBURN",
        "first_name": "LAURA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-05",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A74957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A749570",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "A74957",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

Verify at the official NPI Registry.