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WILBERT TIRTADINATA
NPI 1578177630
Nurse Anesthetist, Certified Registered in Oakland, CA

Active since September 04, 2020Accepts Medicare Assignment
3600 BROADWAY, OAKLAND, CA 94611(510) 752-1000 Get Directions Write a Review

NPPES record last updated: March 13, 2024. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Wilbert Tirtadinata NPPES

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

WILBERT TIRTADINATA (NPI 1578177630) is an individual nurse anesthetist, certified registered in Oakland, California, licensed in California (95002000) and active in the NPI registry since September 2020. He is a graduate of Other (2022).

NPPES Registry Identity

NPI1578177630
Entity TypeIndividualMale
Primary Taxonomy367500000X
Provider Legal NameWILBERT TIRTADINATA
Location Address3600 BROADWAYOakland, CA 94611-5730
Mailing Address3600 BroadwayOakland, CA 94611-5730 · (510) 752-1000
Phone(510) 752-1000
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateSeptember 4, 2020
Last NPPES UpdateMarch 13, 2024
NPPES CertifiedMarch 13, 2024
✔ NPI 1578177630 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367500000X
License✔ Licensed in CA · 95002000
Definition
(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
3600 BROADWAY, Oakland, CA 94611
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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

Wilbert Tirtadinata 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 ID941667851
PECOS Enrollment IDI20230608001585

Medicare Billing Reassignments

5

Medicare enrollment records show Wilbert Tirtadinata reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Amsurg Oakland Anesthesia LP
1.4 mi
Anesthesiology
300 FRANK OGAWA PLAZA, SUITE 135
Oakland, CA 94612
  • Reassigned Medicare billing, California enrollment
  • 48 clinicians in this Medicare group
NPI 1679847727 (510) 893-1600
Permanente Medical Group Inc
9.7 mi
Internal Medicine
901 NEVIN
Richmond, CA 94801
  • Reassigned Medicare billing, California enrollment
  • 20,078 clinicians in this Medicare group
NPI 1235226531 (510) 307-1555
Blue Eagle Anesthesia Inc A Professional Corporation
16 mi
Anesthesiology
901 CAMPUS DR, SUITE 102
Daly City, CA 94015
  • Reassigned Medicare billing, California enrollment
  • 53 clinicians in this Medicare group
NPI 1396822326 (650) 991-2000
In Somno Securitas A Professional Nursing Corporation
191 mi
Nurse Anesthetist, Certified Registered
950 BUTTE ST
Redding, CA 96001
  • Reassigned Medicare billing, California enrollment
  • 32 clinicians in this Medicare group
NPI 1114686631 (530) 223-2500
Genesis Healthcare Partners PC
433 mi
Specialist
320 SANTA FE DR STE 108
Encinitas, CA 92024
  • Reassigned Medicare billing, California enrollment
  • 242 clinicians in this Medicare group
NPI 1548567498 (760) 436-4558

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 94611 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
$153.83 typical visit price
range $69.00 – $202.35
Typical copayment $38.45 (range $17.25 – $50.58)
Most-billed visit code 99204
Established Patient
$84.91 typical visit price
range $23.44 – $166.46
Typical copayment $21.22 (range $5.86 – $41.61)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

OSAMA MOHAMED EL-SAYED MD, PHD
Internal Medicine
3600 BROADWAY
OAKLAND, CA 94611
Alameda County (510) 752-1000
TRAM KHUONG
Pharmacist
3600 BROADWAY
OAKLAND, CA 94611
Alameda County (510) 752-4200
CHRISTIAN F. SCHMUTZ MD
Psychiatry & Neurology (Psychiatry)
3600 BROADWAY
OAKLAND, CA 94611
Alameda County (510) 752-1000
CHRISTOPHER AARON HUDSON RT
Respiratory Therapist, Registered
3600 BROADWAY
OAKLAND, CA 94611
Alameda County (510) 752-8886
DR. TAYLOR RENEE JOHNSON MD, MPH
Orthopaedic Surgery (Pediatric Orthopaedic Surgery)
3600 BROADWAY
OAKLAND, CA 94611
Alameda County (510) 752-1000
ADAM BUIE
Pharmacist
3600 BROADWAY
OAKLAND, CA 94611
Alameda County (510) 752-1000
DR. JUSTIN B FONG MD
Student in an Organized Health Care Education/Training Program
3600 BROADWAY
OAKLAND, CA 94611
Alameda County (510) 752-1000
JASMINE THAI LU MD
Student in an Organized Health Care Education/Training Program
3600 BROADWAY
OAKLAND, CA 94611
Alameda County (510) 752-1000

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 Wilbert Tirtadinata's NPI number?

The NPI number for Wilbert Tirtadinata is 1578177630. It was assigned to this individual provider in the NPPES registry on September 4, 2020.

Where is Wilbert Tirtadinata located?

Wilbert Tirtadinata practices at 3600 Broadway, Oakland, CA 94611. The listed phone number is (510) 752-1000.

What is Wilbert Tirtadinata's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Is Wilbert Tirtadinata enrolled in Medicare?

Yes. Wilbert Tirtadinata 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 Wilbert Tirtadinata's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Wilbert Tirtadinata reassigns Medicare benefits to 5 organizations: Amsurg Oakland Anesthesia LP (Oakland, CA), Permanente Medical Group Inc (Richmond, CA), Blue Eagle Anesthesia Inc A Professional Corporation (Daly City, CA), In Somno Securitas A Professional Nursing Corporation (Redding, CA) and Genesis Healthcare Partners PC (Encinitas, 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 Wilbert Tirtadinata'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 Wilbert Tirtadinata was last updated on March 13, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.