BAY AREA COMPREHENSIVE SPINE AND SPORTS MEDICAL GROUP INC (NPI# 1205928645) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205928645 |
| Entity Type | Organization |
| Organization Name | BAY AREA COMPREHENSIVE SPINE AND SPORTS MEDICAL GROUP INC |
| Practice Address |
5700 Telegraph Ave Ste 100 Oakland CA 94609-1710 |
| Practice Telephone | 5104634700 |
| Practice Fax Number | 5104634722 |
| Mailing Telephone | 5104634700 |
| Mailing Fax Number | 5104634722 |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2019-10-09 |
| Authorized Official Name | DR. MICHAEL KWANSUP PARK (PRESIDENT) |
| Authorized Official Telephone | 5104634700 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2081S0010X |
Physical Medicine & Rehabilitation Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
5700 TELEGRAPH AVE STE 100 |
| City | OAKLAND |
| State | CA |
| Zip Code | 94609-1710 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114088671 | Darren William Guillaume | Physician Assistant | 5700 Telegraph Ave Ste 100, Oakland, CA 94609-1710 | 2006-12-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104457159 | Gerard John-charles Coughlin | Student in an Organized Health Care Education/Training Program | Samuel Merritt University, 3100 Telegraph Avenue, Oakland, CA 94609 | 2020-01-29 |
| 1417502022 | Michael Knittel | Registered Nurse | 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1962057562 | Nicole Kjolby | Registered Nurse | Samuel Merritt College, 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1396208286 | Graham Vallis | Student in an Organized Health Care Education/Training Program | Ucsf Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA 94609 | 2019-04-09 |
| 1386129526 | Gary Mitchell Snider | Counselor | 390 40th Street, Oakland, CA 94609 | 2018-10-02 |
| 1720568389 | Lice Control Inc. | Technician | 6557 Shattuck Ave, Oakland, CA 94609 | 2018-08-14 |
| 1528559150 | Jenna Marie Kincaid | Behavior Technician | 400 29th St., 204, Oakland, CA 94609 | 2018-05-18 |
| 1336656669 | Nicholas Dicarlo | Social Worker | 465 34th St Ste 6, Oakland, CA 94609 | 2018-01-09 |
| 1174045744 | Theodora J Marzouk | Home Health Aide | 3317 Elm Street, Suite 202, Oakland, CA 94609 | 2017-07-14 |
| 1740728922 | Elena Gardella | Marriage & Family Therapist | 411 30th Street, Suite 412, Oakland, CA 94609 | 2017-02-07 |
| Find all providers in zip 94609 | ||||
| Taxonomy Code | 2081S0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Sports Medicine |
| A physician who specializes in Sports Medicine is responsible for continuous care related to the enhancement of health and fitness as well as the prevention of injury and illness. The specialist possesses knowledge and experience in the promotion of wellness and the prevention of injury from many areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation and injuries. It is the goal of a Sports Medicine specialist to improve the healthcare of the individual engaged in physical exercise. |
| Notes: Source: American Board of Medical Specialties, 2009. www.abms.org [7/1/2009: definition added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477150886 | Robin Edwards | Physical Medicine & Rehabilitation | 384 Embarcadero W Fl 3, Oakland, CA 94607-3735 | 2020-10-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518578186 | Tracy Tran Physical Therapy | Physical Medicine & Rehabilitation | 5166 Eagle Rock Blvd, Los Angeles, CA 90041-1115 | 2020-08-16 |
| 1255969143 | Amber Renee Debarge | Physical Medicine & Rehabilitation | 2918 Havasupai Ave, San Diego, CA 92117-1641 | 2020-03-28 |
| 1932734969 | Jasmine Angelina Velasquez | Physical Medicine & Rehabilitation | 12017 Herbert St, Los Angeles, CA 90066-5201 | 2020-03-10 |
| 1275165979 | Coastal Regenerative Orthopedics & Wellness Center Inc. | Physical Medicine & Rehabilitation | 11772 Sorrento Valley Rd Ste 100, San Diego, CA 92121-1016 | 2020-02-10 |
| 1679110407 | Drew Yoder | Physical Medicine & Rehabilitation | Chase Center - Bbops, 1 Warriors Way, San Francisco, CA 94158 | 2019-11-27 |
| 1841831864 | Olivia Carmen Smith | Physical Medicine & Rehabilitation | 2439 Country Club Dr, Glendora, CA 91741-4009 | 2019-10-01 |
| 1538719521 | Kyle Watry | Physical Medicine & Rehabilitation | 550 15th St Ste 36a, San Francisco, CA 94103-5032 | 2019-09-12 |
| 1023679826 | Adrianna Medina | Physical Medicine & Rehabilitation | 279 E Orlando Way, Covina, CA 91723-3016 | 2019-06-24 |
| 1316505563 | Restore The Machine - Physical Therapy Inc | Physical Medicine & Rehabilitation | 23332 Hawthorne Blvd Ste 202, Torrance, CA 90505-3767 | 2019-06-03 |
| 1881163889 | Gaylen Mcginn | Physical Medicine & Rehabilitation | 724 W Maple Ave Apt A, Orange, CA 92868-5022 | 2018-11-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.