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JI YEONG GENDRON SONG
NPI 1033788898
Nurse Practitioner - Family in Walnut Creek, CA

Active since June 24, 2021PECOS Enrolled
86.35/100
CMS Quality Rating
738 BANCROFT ROAD, WALNUT CREEK, CA 94598(925) 938-8525 Get Directions Write a Review

NPPES record last updated: June 26, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Feb 4, 2022, Jun 24, 2021 (2 updates tracked since 2021).

About Ji Yeong Gendron Song NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JI YEONG GENDRON SONG (NPI 1033788898) is an individual family provider in Walnut Creek, California, licensed in California (95017511) and active in the NPI registry since June 2021. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1033788898
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameJI YEONG GENDRON SONG
Location Address738 BANCROFT ROADWalnut Creek, CA 94598-1250
Mailing Address738 Bancroft RoadWalnut Creek, CA 94598 · (925) 938-8525
Phone(925) 938-8525
Sole ProprietorYes
Enumeration DateJune 24, 2021
Last NPPES UpdateJune 26, 20232 updates tracked since enumeration
NPPES CertifiedJune 26, 2023
✔ NPI 1033788898 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
Licenses✔ Licensed in CA · 95017511✔ Licensed in CA · NP95017511
738 BANCROFT ROAD, Walnut Creek, CA 94598
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ji Yeong Gendron Song is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Ji Yeong Gendron Song reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

The Davis Street Community Center Incorporated
17 mi
Federally Qualified Health Center (FQHC)
3081 TEGARDEN
San Leandro, CA 94577
  • Reassigned Medicare billing, California enrollment
  • 42 clinicians in this Medicare group
NPI 1215358924 (510) 347-4620
Bay Area Pl Services
29 mi
Emergency Medicine
841 SAN BRUNO AVE W STE 100
San Bruno, CA 94066
  • Reassigned Medicare billing, California enrollment
  • 2 clinicians in this Medicare group
NPI 1932858628 (415) 300-4436

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 94598 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$104.51 typical visit price
range $69.00 – $202.35
Typical copayment $26.12 (range $17.25 – $50.58)
Most-billed visit code 99203
Established Patient
$119.48 typical visit price
range $23.44 – $166.46
Typical copayment $29.87 (range $5.86 – $41.61)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

86.35/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality77.06
Improvement Activities40
Cost90.15

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ji Yeong Gendron Song's NPI number?

The NPI number for Ji Yeong Gendron Song is 1033788898. It was assigned to this individual provider in the NPPES registry on June 24, 2021.

Where is Ji Yeong Gendron Song located?

Ji Yeong Gendron Song practices at 738 Bancroft Road, Walnut Creek, CA 94598. The listed phone number is (925) 938-8525.

What is Ji Yeong Gendron Song's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Ji Yeong Gendron Song enrolled in Medicare?

Yes. Ji Yeong Gendron Song is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Ji Yeong Gendron Song's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ji Yeong Gendron Song reassigns Medicare benefits to 2 organizations: The Davis Street Community Center Incorporated (San Leandro, CA) and Bay Area Pl Services (San Bruno, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Ji Yeong Gendron Song's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Ji Yeong Gendron Song was last updated on June 26, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.