CASEY S REVENKO (NPI# 1790341618) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790341618 |
| Entity Type | Individual |
| Full Name | CASEY S REVENKO |
| Credential | PHYSICIAN ASSISTANT |
| Practice Address |
2999 Regent St Ste 225 Berkeley CA 94705-2117 |
| Mailing Address |
2525 Golden Rain Rd Apt 5 Walnut Creek CA 94595-1938 |
| Practice Telephone | 5107047760 |
| Practice Fax Number | 5107047765 |
| Mailing Telephone | 9253602025 |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2019-05-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
PA56633 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
2999 REGENT ST STE 225 |
| City | BERKELEY |
| State | CA |
| Zip Code | 94705-2117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447882956 | Diane Lomas Wyatt | Marriage & Family Therapist | 2340 Ward St. Ste 104, Berkeley, CA 94705 | 2020-02-12 |
| 1700371275 | Icecreamwala Dermatology Inc | Dermatology | 2435 Webster St Ste 101, Berkeley, CA 94705 | 2018-06-27 |
| 1396253803 | David R Shaddock | Marriage & Family Therapist | 3030 Ashby Avenue, # 105, Berkeley, CA 94705 | 2018-01-18 |
| 1821504432 | Allegra Tringali | Physical Therapist | 2450 Ashby Ave Fl 6, Berkeley, CA 94705 | 2017-12-19 |
| 1659898740 | Hunter Brown | Student in an Organized Health Care Education/Training Program | Wright Institute Clinical Services 1918 University Ave, Suite 2b, Berkeley, CA 94705 | 2017-08-29 |
| 1588014534 | Heather Valdez | Social Worker | 2185 Ashby Ave, Berkeley, CA 94705 | 2016-06-20 |
| 1215350145 | S.e.e.d.s. (social and Emotional Education Development and Support) | Community/Behavioral Health | 3120 Telegraph Avenue Ste 9, Berkeley, CA 94705 | 2014-01-29 |
| 1144580960 | Benjamin Tucker | Counselor | 2625 Alcatraz Ave Ste 609, Berkeley, CA 94705 | 2012-05-26 |
| 1881966141 | Jennifer Cowherd | Behavioral Analyst | 2201 Woolsey St, Berkeley, CA 94705 | 2012-02-02 |
| 1518255892 | Erika D Huguenard | Counselor | 2811a College Avenue, Berkeley, CA 94705 | 2011-07-20 |
| Find all providers in zip 94705 | ||||
| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053501320 | Terence J Mcdonnell Md Professional Corp | Orthopaedic Surgery | 2999 Regent Street, Suite 710, Berkeley, CA 94705-2117 | 2007-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225504301 | Amgad Alfred | Orthopaedic Surgery | 18145 Us Highway 18 Ste D, Apple Valley, CA 92307-2210 | 2018-10-16 |
| 1386136430 | Valley River Orthopedics and Sports Medicine | Orthopaedic Surgery | Valley River Orthopedics & Sports Medicine Inc, 3329 G St Ste A, Merced, CA 95340 | 2018-06-05 |
| 1073026696 | Optimal Physician Surgical Group | Orthopaedic Surgery | 25067 Jim Bridger Rd, Hidden Hills, CA 91302-1128 | 2017-11-06 |
| 1336669456 | Beach Cities Orthopedics Surgery Center, LLC | Orthopaedic Surgery | 400 S Sepulveda Blvd Ste 110, Manhattan Beach, CA 90266-6814 | 2017-06-20 |
| 1750818860 | Health Link Medical Group Inc | Orthopaedic Surgery | 899 Northgate Dr Ste 400, San Rafael, CA 94903-3667 | 2017-05-19 |
| 1962861476 | Mehta Orthopedics | Orthopaedic Surgery | 32145 Alvarado Niles Rd Ste 209, Union City, CA 94587-2930 | 2016-02-12 |
| 1649646282 | Bay Area Surgical Specialists, Inc. A Medical Corporation | Orthopaedic Surgery | 5924 Stoneridge Dr Ste 202, Pleasanton, CA 94588-5400 | 2015-08-18 |
| 1114346111 | Sean Robinson | Orthopaedic Surgery | 7551 Timberlake Way Ste 200, Sacramento, CA 95823-5422 | 2014-04-08 |
| 1851717938 | William R Campbell Do Prof Corp | Orthopaedic Surgery | 1 Daniel Burnham Ct Ste 365c, San Francisco, CA 94109-5490 | 2014-03-12 |
| 1487079810 | Kazimierz Walter Komperda | Orthopaedic Surgery | 800 S Raymond Ave Fl 2, Pasadena, CA 91105-3229 | 2014-02-21 |
| 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.