Organization Active NPI

Robert R. Anderson M.D., Inc.

  • Ophthalmology Physician
  • Greenbrae, CA
National Provider Identifier
1962695304
Registry record updated Aug 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
ROBERT R. ANDERSON M.D., INC.
Practice address
900 S Eliseo Dr
Suite 102
Greenbrae, CA 94904-2134
Phone
(415) 461-8200
Fax
(415) 461-4627
NPI assigned
Aug 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2007

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

Authorized official

Name
Dr. Robert R. Anderson, M.D.
Title
President
Phone
(415) 461-8200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

900 S Eliseo Dr
Suite 102
Greenbrae, CA 94904-2134

Mailing address

900 S Eliseo Dr
Suite 102
Greenbrae, CA 94904-2134
Phone (415) 461-8200

Other identifiers 1

IdentifierTypeStateIssuer
00G305540MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161117001049 CA Part B Supplier - Clinic/Group Practice 9739468653 Receives reassigned benefits from 4 practitioners
Practice locations: Greenbrae, CA

National Provider Directory

National Provider Directory

Locations

1 Thorndale Dr
Ste 210
San Rafael, CA 94903
Phone (415) 233-4202

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187568000000",
    "number": "1962695304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 S ELISEO DR",
            "address_2": "SUITE 102",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949042134",
            "telephone_number": "415-461-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 S ELISEO DR",
            "address_2": "SUITE 102",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949042134",
            "telephone_number": "415-461-8200",
            "fax_number": "415-461-4627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT R. ANDERSON M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-20",
        "last_updated": "2007-08-20",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "415-461-8200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G305540",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenbrae, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.