CARDIOVASCULAR CONSULTANTS MEDICAL GROUP, INC. (NPI# 1629013842) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629013842 |
| Entity Type | Organization |
| Organization Name | CARDIOVASCULAR CONSULTANTS MEDICAL GROUP, INC. |
| Practice Address |
365 Hawthorne Ave #201 Oakland CA 94609-3107 |
| Mailing Address |
2855 Mitchell Dr #223 Walnut Creek CA 94598-1600 |
| Practice Telephone | 5104521345 |
| Practice Fax Number | 5104521102 |
| Mailing Telephone | 5104521345 |
| Mailing Fax Number | 5104521102 |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2010-06-25 |
| Authorized Official Name | PAUL L LUDMER (PRESIDENT) |
| Authorized Official Telephone | 5104521345 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
Allopathic & Osteopathic Physicians | ||
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BLUE SHIELD PROVIDER NUMBER | ZZZ56221Z | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770780355 | Cardiovascular Consultants Medical Group, Inc. | Internal Medicine | 2855 Mitchell Dr Ste 223, Walnut Creek, CA 94598-1609 | 2007-06-28 |
| 1720225808 | Cardiovascular Consultants Medical Group, Inc. | Internal Medicine | 6380 Clark Ave, Dublin, CA 94568-3036 | 2009-01-12 |
| 1538197413 | Cardiovascular Consultants Medical Group, Inc. | Internal Medicine | 106 La Casa Via, #140, Walnut Creek, CA 94598-3086 | 2006-06-29 |
| 1710922034 | Cardiovascular Consultants Medical Group, Inc. | Internal Medicine | 5201 Norris Canyon Rd, #220, San Ramon, CA 94583-5411 | 2006-06-19 |
| 1437194750 | Cardiovascular Consultants Medical Group, Inc. | Internal Medicine | 2400 Balfour Rd, #215, Brentwood, CA 94513-4945 | 2006-06-19 |
| 1275578478 | Cardiovascular Consultants Medical Group, Inc. | Internal Medicine | 400 Taylor Blvd, #101, Pleasant Hill, CA 94523-2147 | 2006-06-19 |
| 1437194677 | Cardiovascular Consultants Medical Group, Inc. | Internal Medicine | 20126 Stanton Ave, #100, Castro Valley, CA 94546-5271 | 2006-06-19 |
| Street Address |
365 HAWTHORNE AVE #201 |
| City | OAKLAND |
| State | CA |
| Zip Code | 94609-3107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184686156 | Rupert Roupen Horoupian | Specialist | 365 Hawthorne Ave, Suite 101, Oakland, CA 94609-3107 | 2006-04-05 |
| 1588061378 | First Surgical Consultants | General Acute Care Hospital | 365 Hawthorne Ave, 101, Oakland, CA 94609-3107 | 2014-11-24 |
| 1477826683 | Kelley Lockwood Brennan | Nurse Practitioner | 365 Hawthorne Ave, Suite 301, Oakland, CA 94609-3107 | 2012-02-17 |
| 1891084117 | Debbie Choi Man Chan | Physician Assistant | 365 Hawthorne Ave, #201, Oakland, CA 94609-3107 | 2011-04-07 |
| 1679701858 | Cheruba Prabakar | Obstetrics & Gynecology | 365 Hawthorne Ave, Ste 301, Oakland, CA 94609-3107 | 2009-06-26 |
| 1487813697 | Christa Kong | Physician Assistant | 365 Hawthorne Ave, Suite 201, Oakland, CA 94609-3107 | 2008-06-03 |
| 1922205442 | Associated Neurology Medical Group, Inc. | Psychiatry & Neurology | 365 Hawthorne Ave, Suite 203, Oakland, CA 94609-3107 | 2007-06-28 |
| 1720284011 | Thomas Raymond Hardey | Clinical Neuropsychologist | 365 Hawthorne Ave, Suite 104, Oakland, CA 94609-3107 | 2007-06-22 |
| 1992913859 | Diane Kwan | Surgery | 365 Hawthorne Ave, Suite 101, Oakland, CA 94609-3107 | 2007-05-21 |
| 1598806986 | Douglas Stannage Patton | Surgery | 365 Hawthorne Ave, Suite 101, Oakland, CA 94609 | 2007-02-09 |
| Find all providers in the same location | ||||
| 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 | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417157652 | Mitul Kadakia | Internal Medicine | 365 Hawthorne Ave Ste 201, Oakland, CA 94609-3114 | 2007-07-24 |
| 1407992001 | James Edward Lai | Internal Medicine | 365 Hawthorne Ave Ste 201, Oakland, CA 94609-3114 | 2007-01-30 |
| 1811047525 | Terrence C. Wong | Internal Medicine | 275 W Macarthur, Oakland, CA 94611-5641 | 2007-01-12 |
| 1083788145 | William K Lee | Internal Medicine | 43 Yawpo Ave, Oakland, NJ 07436 | 2006-11-20 |
| 1104990266 | Navin Budhwani | Internal Medicine | 43 Yawpo Ave, Oakland, NJ 07436 | 2006-11-20 |
| 1720157167 | Ronald K. L. Szeto M.d. A Professional Corporation | Internal Medicine | 3100 Telegraph Ave, Suite 4103, Oakland, CA 94609-3210 | 2006-11-07 |
| 1295813079 | Robert A. Cooper | Internal Medicine | 275 W Macarthur, Oakland, CA 94611-5641 | 2006-11-01 |
| 1689752479 | Ralph G. Brindis | Internal Medicine | 280 W Macarthur Blvd, Oakland, CA 94611-5642 | 2006-11-01 |
| 1588742381 | Garwood Gee | Internal Medicine | 275 W Macarthur, Oakland, CA 94611-5641 | 2006-11-01 |
| 1124108808 | David H Montgomery | Internal Medicine | 43 Yawpo Ave, Oakland, NJ 07436 | 2006-10-16 |
| Find all providers in OAKLAND | ||||
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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.