NPIMap

Individual provider Active NPI

Robert E Gwynn, MD

  • Interventional Cardiology Physician
  • Berkeley, CA
National Provider Identifier
1942236401
Registry record updated Sep 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
G16492 Issued in CA
Practice address
132 Southampton Ave
Berkeley, CA 94707-2037
Phone
(510) 524-2848
Fax
(510) 524-9358
NPI assigned
Jun 24, 2006
Last updated
Sep 17, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X G16492 CA Primary

Addresses

Primary practice location

132 Southampton Ave
Berkeley, CA 94707-2037

Mailing address

132 Southampton Ave
Berkeley, CA 94707-2037
Phone (510) 524-2848

Other identifiers 1

IdentifierTypeStateIssuer
GR0030860MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070209000407 CA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 4880617380 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
JS Weill Medical College, Cornell University, 1965
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alameda Health SystemGroup PAC ID 3779494521, 597 clinicians

Practice addresses (Care Compare)

1411 E 31St St
Oakland, CA 94602-1018
Phone (510) 437-4800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.17 of 100Reported as group
Quality
86.93
Promoting interoperability
100
Improvement activities
40
Cost
72.6

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G16492CAMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alameda Health System CurrentSince Mar 12, 2015 Accepting new patients
Alameda Health System CurrentSince Mar 12, 2015 Accepting new patients
Alta Bates Summit Medical Center Past Accepting new patients
Alameda Health System Past Accepting new patients
Eden Medical Center/San Leandro Hospital Campus Past Accepting new patients

Locations

664 Southland Mall
Hayward, CA 94545
Phone (510) 266-1700

6066 Civic Terrace Ave
Newark, CA 94560
Phone (510) 505-1600

1411 E 31st St
Oakland, CA 94602
Phone (510) 437-4323

6955 Foothill Blvd
Ste 200
Oakland, CA 94605
Phone (510) 567-5700

7677 Oakport St
Ste 1200
Oakland, CA 94621
Phone (510) 618-5768

Interoperability endpoints

  • Direct secure messaging: rgwynn14211@alamedahs.direct-ci.com

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 5

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": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379376000000",
    "number": "1942236401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 SOUTHAMPTON AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947072037",
            "telephone_number": "510-524-2848",
            "fax_number": "510-524-9358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 SOUTHAMPTON AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947072037",
            "telephone_number": "510-524-2848",
            "fax_number": "510-524-9358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWYNN",
        "first_name": "ROBERT",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-24",
        "last_updated": "2013-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CA",
            "license": "G16492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030860",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.