| Pine Park Health, Inc | |
|
1901 4th St Ste 201 Berkeley CA 94710-1986 | |
| (510) 929-1400 | |
| (510) 929-1414 |
| Full Name | Pine Park Health, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1901 4th St Ste 201, Berkeley, California |
| Authorized Official Name and Position | Stephanie Vanzee (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 4694018820 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Park Health, Inc Po Box 511250 Los Angeles CA 90051-7805 Ph: (510) 929-1400 | Pine Park Health, Inc 1901 4th St Ste 201 Berkeley CA 94710-1986 Ph: (510) 929-1400 |
| NPI Number | 1346879848 |
|---|---|
| Provider Enumeration Date | 04/06/2020 |
| Last Update Date | 02/04/2025 |
| Medicare PECOS PAC ID | 0345670527 |
|---|---|
| Medicare Enrollment ID | O20200501001068 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346879848 | NPI | - | NPPES |
| Provider Name | Melissa B Vourlitis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235236977 PECOS PAC ID: 4587686852 Enrollment ID: I20051229000756 |
| Provider Name | Payam Parvinchiha |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851690622 PECOS PAC ID: 5092953760 Enrollment ID: I20130608000033 |
| Provider Name | Edward Robert Teare |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871832287 PECOS PAC ID: 8426294844 Enrollment ID: I20160215000320 |
| Provider Name | Michael Feinberg |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1841682036 PECOS PAC ID: 8628350501 Enrollment ID: I20170130001584 |
| Provider Name | Teklehaimanot Abraha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013441229 PECOS PAC ID: 8628340874 Enrollment ID: I20170822004090 |
| Provider Name | Taylor Rose Semrad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144770801 PECOS PAC ID: 3870856149 Enrollment ID: I20180419001296 |
| Provider Name | Myla Thong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982162970 PECOS PAC ID: 9931533973 Enrollment ID: I20200715000136 |
| Provider Name | Michael David Genualdi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124482823 PECOS PAC ID: 0143648790 Enrollment ID: I20200914001181 |
| Provider Name | Erin Kathleen Alicia O'hair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710259361 PECOS PAC ID: 3971802919 Enrollment ID: I20210329001089 |
| Provider Name | Brittany Michele Demont |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316692841 PECOS PAC ID: 3577958958 Enrollment ID: I20220322000926 |
| Provider Name | Sara Gopsill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831717982 PECOS PAC ID: 4880019561 Enrollment ID: I20230412002923 |
| Provider Name | Ashton Price |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053814681 PECOS PAC ID: 2961863931 Enrollment ID: I20230807003528 |
| Provider Name | Laura Christine Eichinger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801662168 PECOS PAC ID: 8820448913 Enrollment ID: I20240102003250 |
| Provider Name | Jessica Muthoni Ndiritu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205507142 PECOS PAC ID: 9931549276 Enrollment ID: I20240502003632 |
| Provider Name | Lauren Dewalt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346603248 PECOS PAC ID: 0244771087 Enrollment ID: I20240920001106 |
| Provider Name | Margot Schmidt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154130946 PECOS PAC ID: 1456889021 Enrollment ID: I20250109002552 |
| Provider Name | Amanda Marie Ilag |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114745783 PECOS PAC ID: 5193254779 Enrollment ID: I20250128000862 |
| Provider Name | April Alice Koehler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356157200 PECOS PAC ID: 6709300957 Enrollment ID: I20250409000534 |
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