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ANDREA BANOUVONG
NPI 1073137634
Nurse Practitioner in San Lorenzo, CA

Active since May 29, 2020PECOS EnrolledAccepts Medicare Assignment
927 VIA HONDA, SAN LORENZO, CA 94580(510) 407-0749 Get Directions Write a Review

NPPES record last updated: May 29, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Andrea Banouvong NPPES

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

ANDREA BANOUVONG (NPI 1073137634) is an individual nurse practitioner in San Lorenzo, California, licensed in California (95013507) and active in the NPI registry since May 2020. She is enrolled in Medicare PECOS and is a graduate of University Of California, San Francisco School Of Medicine (2019).

NPPES Registry Identity

NPI1073137634
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameANDREA BANOUVONG
Location Address927 VIA HONDASan Lorenzo, CA 94580-2815
Mailing Address927 Via HondaSan Lorenzo, CA 94580-2815 · (510) 407-0749
Phone(510) 407-0749
Sole ProprietorYes
Medical School CMSUniversity Of California, San Francisco School Of MedicineGraduated 2019
Enumeration DateMay 29, 2020
NPPES CertifiedMay 29, 2020
✔ NPI 1073137634 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in CA · 95013507
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Also ListedNurse Practitioner · Acute CareTaxonomy 363LA2100X · License 95013507 (CA)
927 VIA HONDA, San Lorenzo, CA 94580
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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 and accepts Medicare assignment

Andrea Banouvong is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1759768658
PECOS Enrollment IDI20220516000575
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

3

Medicare enrollment records show Andrea Banouvong reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Sutter Bay Hospitals
2.9 mi
General Acute Care Hospital
20103 LAKE CHABOT ROAD
Castro Valley, CA 94546
  • Reassigned Medicare billing, California enrollment
  • 132 clinicians in this Medicare group
NPI 1063812907 (510) 537-1234
Sutter Bay Medical Foundation
12 mi
Ambulatory Surgical
3140 KEARNEY ST
Fremont, CA 94538
NPI 1497996524 (510) 498-2819
South Salem Rehabilitation, LLC
500 mi
Skilled Nursing Facility
3445 BOONE RD SE
Salem, OR 97317
  • Reassigned Medicare billing, Oregon and Washington enrollments
  • Medicare enrollment name: Kaiser Foundation Health Plan Of The Northwest
  • Also billed through NPI 1871848457 (Washington)
  • 3,207 clinicians in this Medicare group
NPI 1215071998 (503) 576-3000

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 94580 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.

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 Andrea Banouvong's NPI number?

The NPI number for Andrea Banouvong is 1073137634. It was assigned to this individual provider in the NPPES registry on May 29, 2020.

Where is Andrea Banouvong located?

Andrea Banouvong practices at 927 Via Honda, San Lorenzo, CA 94580. The listed phone number is (510) 407-0749.

What is Andrea Banouvong's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Andrea Banouvong enrolled in Medicare?

Yes. Andrea Banouvong is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Andrea Banouvong's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Andrea Banouvong reassigns Medicare benefits to 3 organizations: Sutter Bay Hospitals (Castro Valley, CA), Sutter Bay Medical Foundation (Fremont, CA) and South Salem Rehabilitation, LLC (Salem, OR). 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 Andrea Banouvong'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 Andrea Banouvong was last updated on May 29, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.