Davis Street Primary Care Clinic - Medicare Primary Care in San Leandro, CA

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Davis Street Primary Care Clinic is a medicare enrolled primary clinic (Clinic/center - Federally Qualified Health Center (fqhc)) in San Leandro, California. The current practice location for Davis Street Primary Care Clinic is 3081 Tegarden, San Leandro, California. For appointments, you can reach them via phone at (510) 347-4620. The mailing address for Davis Street Primary Care Clinic is 3081 Tegarden Street, San Leandro, California and phone number is (510) 347-4620.

Davis Street Primary Care Clinic is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1215358924. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (510) 347-4620.

Contact Information

Davis Street Primary Care Clinic
3081 Tegarden
San Leandro
CA 94577-5720
(510) 347-4620
(510) 486-4486

Map and Direction


Primary Care Clinic Profile

Full NameDavis Street Primary Care Clinic
SpecialityClinic/Center
Location3081 Tegarden, San Leandro, California
Authorized Official Name and PositionRosalia Aquino Mcmillen (CHIEF FISCAL OFFICER)
Authorized Official Contact5103474620
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Davis Street Primary Care Clinic
3081 Tegarden Street
San Leandro
CA 94577-5720

Ph: (510) 347-4620		Davis Street Primary Care Clinic
3081 Tegarden
San Leandro
CA 94577-5720

Ph: (510) 347-4620

NPI Details:

NPI Number1215358924
Provider Enumeration Date12/23/2013
Last Update Date04/01/2020

Medicare PECOS Information:

Medicare PECOS PAC ID6800956079
Medicare Enrollment IDO20141204000241

Medical Identifiers

Medical identifiers for Davis Street Primary Care Clinic such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1215358924NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
261QC1500XClinic/center - Community Health (* (Not Available))Secondary
261QD0000XClinic/center - Dental (* (Not Available))Secondary
261QF0400XClinic/center - Federally Qualified Health Center (fqhc) (* (Not Available))Primary
261QM0850XClinic/center - Adult Mental Health (* (Not Available))Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Davis Street Primary Care Clinic acts as a billing entity for following providers:
Provider NameSusan C Eile
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1669483269
PECOS PAC ID: 8921090523
Enrollment ID: I20040401001844
Provider NameXuananh Pham Tran
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1689616690
PECOS PAC ID: 6608837547
Enrollment ID: I20041022001150
Provider NameMark J Finch
Provider TypePractitioner - Infectious Disease
Provider IdentifiersNPI Number: 1730248196
PECOS PAC ID: 2769432160
Enrollment ID: I20050124000833
Provider NameElizabeth A Ruben
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1629104476
PECOS PAC ID: 2860435708
Enrollment ID: I20050603000286
Provider NameSreedevi J Ayyala
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1093893679
PECOS PAC ID: 9830105428
Enrollment ID: I20060307000201
Provider NameThomas Luck
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1528016011
PECOS PAC ID: 5799752671
Enrollment ID: I20080125000552
Provider NameTuyen T Tran
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1316049646
PECOS PAC ID: 2769564988
Enrollment ID: I20080128000255
Provider NameCharles T Clemons
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1730239542
PECOS PAC ID: 9133032238
Enrollment ID: I20080401000885
Provider NameShirley A Tamoria
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1952489577
PECOS PAC ID: 3971510686
Enrollment ID: I20101202001343
Provider NameRuben Ruiz
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1235297318
PECOS PAC ID: 4385826320
Enrollment ID: I20110311000231
Provider NameMarjorie Alexander Smith
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1386734747
PECOS PAC ID: 8224211925
Enrollment ID: I20110317000435
Provider NameRosa E Heredia
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1033212691
PECOS PAC ID: 2163555640
Enrollment ID: I20120104000335
Provider NameGerald O Coats
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1114979879
PECOS PAC ID: 4880616689
Enrollment ID: I20141222000551
Provider NameJennifer Lui
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1306101076
PECOS PAC ID: 4789908385
Enrollment ID: I20150129001961
Provider NameRajendra Manoharan Ratnesar
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1104031376
PECOS PAC ID: 1254301963
Enrollment ID: I20150225001991
Provider NameTeisha M Turner
Provider TypePractitioner - Clinical Psychologist
Provider IdentifiersNPI Number: 1841441094
PECOS PAC ID: 3173840543
Enrollment ID: I20150323002649
Provider NameJudith Tinkelenberg
Provider TypePractitioner - Certified Nurse Midwife (cnm)
Provider IdentifiersNPI Number: 1023106622
PECOS PAC ID: 1850610916
Enrollment ID: I20150512001650
Provider NameStella Morden
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1013220581
PECOS PAC ID: 5799970695
Enrollment ID: I20150521002061
Provider NameNadieh Samiaei
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1821409533
PECOS PAC ID: 1850606518
Enrollment ID: I20150811003695
Provider NameEilly Yang
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1699145342
PECOS PAC ID: 4981901618
Enrollment ID: I20160324000568
Provider NameJoan Alviar Fraino
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1487025375
PECOS PAC ID: 6608167978
Enrollment ID: I20160616000164
Provider NameAarti Gupta
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1831370451
PECOS PAC ID: 9830276260
Enrollment ID: I20170518001345
Provider NameCelia R Gong
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1619498656
PECOS PAC ID: 5193098341
Enrollment ID: I20170908003231
Provider NameEric D Wells
Provider TypePractitioner - Emergency Medicine
Provider IdentifiersNPI Number: 1386658730
PECOS PAC ID: 0547520322
Enrollment ID: I20180216001583
Provider NameKaren Gold
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1003023946
PECOS PAC ID: 5496980286
Enrollment ID: I20181012002641
Provider NameDiana M Mokaya
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1023458528
PECOS PAC ID: 3274876305
Enrollment ID: I20190513002402
Provider NamePamela Di Franco
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1104480581
PECOS PAC ID: 3678807567
Enrollment ID: I20190626002794
Provider NameGerdy M Pluviose
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1285132175
PECOS PAC ID: 4284996133
Enrollment ID: I20191024002457
Provider NameKhushbu Aggarwal
Provider TypePractitioner - Dentist
Provider IdentifiersNPI Number: 1841604048
PECOS PAC ID: 0042542581
Enrollment ID: I20191101000903
Provider NameOscar David Becerra
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1316931439
PECOS PAC ID: 4284683012
Enrollment ID: I20191101002374
Provider NameDiana Samardzic
Provider TypePractitioner - Clinical Psychologist
Provider IdentifiersNPI Number: 1336350651
PECOS PAC ID: 6901238963
Enrollment ID: I20191112002812
Provider NameRaman Emanuel Nazari
Provider TypePractitioner - Dentist
Provider IdentifiersNPI Number: 1871088971
PECOS PAC ID: 2668806969
Enrollment ID: I20191219000959
Provider NameMary Jean Shimane
Provider TypePractitioner - Dentist
Provider IdentifiersNPI Number: 1851848196
PECOS PAC ID: 7214361187
Enrollment ID: I20191231001186
Provider NameRistina Ingram
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1720544596
PECOS PAC ID: 0941634661
Enrollment ID: I20200103002429
Provider NameJoshwin Raji Hall
Provider TypePractitioner - Dentist
Provider IdentifiersNPI Number: 1043637010
PECOS PAC ID: 1951728039
Enrollment ID: I20200903002102
Provider NameJi Yeong Gendron Song
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1033788898
PECOS PAC ID: 5890197511
Enrollment ID: I20210716001481
Provider NameSze Kei Yeung
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1376206177
PECOS PAC ID: 5294125613
Enrollment ID: I20211129001564
Provider NameMaria Hannah Tiangha Mandecote
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1669192969
PECOS PAC ID: 2567833528
Enrollment ID: I20230130002261
Provider NameMayra Carmina Alvarez
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1730797069
PECOS PAC ID: 7719351493
Enrollment ID: I20230320002186
Provider NameEricka Ledesma
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1598358566
PECOS PAC ID: 0941674204
Enrollment ID: I20230328001604
Provider NameBarbara L. Johnston
Provider TypePractitioner - Clinical Psychologist
Provider IdentifiersNPI Number: 1982924965
PECOS PAC ID: 2961877980
Enrollment ID: I20230405001079
Provider NameKathy Ka Yee Wong
Provider TypePractitioner - Dentist
Provider IdentifiersNPI Number: 1467076893
PECOS PAC ID: 2163875642
Enrollment ID: I20240131004011
Provider NameSu Ping Mai
Provider TypePractitioner - Dentist
Provider IdentifiersNPI Number: 1629592456
PECOS PAC ID: 3870931595
Enrollment ID: I20240401001700

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.