| East Bay Aids Center Medical Group Inc | |
|
3100 Summit St 2nd Floor Oakland CA 94609-3410 | |
| (510) 869-8400 | |
| (510) 869-8475 |
| Full Name | East Bay Aids Center Medical Group Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3100 Summit St, Oakland, California |
| Authorized Official Name and Position | Jeffrey Burack (PRESIDENT) |
| Authorized Official Contact | 5108698480 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Bay Aids Center Medical Group Inc 3100 Summit St, 2nd Floor Oakland CA 94609 Ph: (510) 869-8488 | East Bay Aids Center Medical Group Inc 3100 Summit St 2nd Floor Oakland CA 94609-3410 Ph: (510) 869-8400 |
| NPI Number | 1689600314 |
|---|---|
| Provider Enumeration Date | 06/24/2006 |
| Last Update Date | 12/22/2022 |
| Medicare PECOS PAC ID | 2668497843 |
|---|---|
| Medicare Enrollment ID | O20051006000615 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689600314 | NPI | - | NPPES |
| GR0087700 | Medicaid | CA |
| Provider Name | Lisa I Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568524247 PECOS PAC ID: 6305892720 Enrollment ID: I20050329000219 |
| Provider Name | Stephen O'brien |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699794453 PECOS PAC ID: 8729003900 Enrollment ID: I20051110000576 |
| Provider Name | Jeffrey H Burack |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316967474 PECOS PAC ID: 3274551916 Enrollment ID: I20051110000598 |
| Provider Name | Hyman Scott |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528233913 PECOS PAC ID: 8820148901 Enrollment ID: I20090611000132 |
| Provider Name | Michele Wen Tang |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1851680797 PECOS PAC ID: 1052539640 Enrollment ID: I20140822001629 |
| Provider Name | Stephen A Merjavy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326477993 PECOS PAC ID: 0648403956 Enrollment ID: I20180125001062 |
| Provider Name | Kentaro J Kaneko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992272223 PECOS PAC ID: 1052720240 Enrollment ID: I20210428002589 |
| Provider Name | Mollie S Hudson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487266292 PECOS PAC ID: 6901215177 Enrollment ID: I20210429002863 |
| Provider Name | Carissa J Perkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053047803 PECOS PAC ID: 4688044829 Enrollment ID: I20230103002809 |
| Provider Name | Mathew R Sommers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467188516 PECOS PAC ID: 4981075207 Enrollment ID: I20230125001269 |
| Provider Name | Lauren E Mellor-crummey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306474382 PECOS PAC ID: 3476946500 Enrollment ID: I20230906000293 |
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