PENINSULA SURGICAL SPECIALIST MEDICAL GROUP, INC. (NPI# 1720176225) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720176225 |
| Entity Type | Organization |
| Organization Name | PENINSULA SURGICAL SPECIALIST MEDICAL GROUP, INC. |
| Other Organization Name | SURGICAL ASSOCIATES OF THE PENINSULA A MEDICAL GROUP, INC. |
| Practice Address |
1720 El Camino Real Suite 101 Burlingame CA 94010-3224 |
| Practice Telephone | 6506520600 |
| Mailing Telephone | 6506520600 |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2008-03-10 |
| Authorized Official Name | DR. DIRK BAUMANN (CFO) |
| Authorized Official Telephone | 6507774064 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | SURGICAL ASSOCIATES OF THE PENINSULA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 246ZS0410X |
Specialist/Technologist, Other Specialization: Surgical Technologist |
Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | RAILROAD MEDICARE | P00411831 | 01 |
| CA | RAILROAD MEDICARE | CG1015 | 01 |
| CA | RAILROAD MEDICARE | P00405374 | 01 |
| CA | RAILROAD MEDICARE | P00431764 | 01 |
| Other Name | Type Code |
|---|---|
| Surgical Associates of the Peninsula A Medical Group, Inc. | Doing Business As Name - Organization |
| Street Address |
1720 EL CAMINO REAL SUITE 101 |
| City | BURLINGAME |
| State | CA |
| Zip Code | 94010-3224 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861486359 | Lisa A. Frey | Nurse Practitioner | 1720 El Camino Real, Suite 130, Burlingame, CA 94010-3224 | 2005-09-10 |
| 1922462431 | Sutter Bay Hospitals | Custodial Care Facility | 1720 El Camino Real, Suite 10, Burlingame, CA 94010-3224 | 2016-04-11 |
| 1801264874 | Lillian Nelson | Nurse Practitioner | 1720 El Camino Real, Burlingame, CA 94010-3224 | 2015-09-08 |
| 1164763231 | Anne Thai Md, A Professional Corporation | Internal Medicine | 1720 El Camino Real, Suite Number 155, Burlingame, CA 94010-3224 | 2013-03-14 |
| 1720352636 | Aaron M. Roland | Family Medicine | 1720 El Camino Real, 130, Burlingame, CA 94010-3224 | 2012-02-24 |
| 1861765901 | Victor Liu | Specialist | 1720 El Camino Real, Suite 200, Burlingame, CA 94010-3224 | 2012-02-21 |
| 1689942062 | Howard A Cohen Md, Inc | Specialist | 1720 El Camino Real, Ste 210, Burlingame, CA 94010-3224 | 2011-12-13 |
| 1902173388 | Peggy Zeng | Optometrist | 1720 El Camino Real, Suite 225, Burlingame, CA 94010-3224 | 2011-11-29 |
| 1548566177 | Aditi Chandra | Internal Medicine | 1720 El Camino Real, Ste 160, Burlingame, CA 94010-3224 | 2011-01-29 |
| 1548583651 | Peninsula Endoscopy Center LLC | Clinic/Center | 1720 El Camino Real, Suite 100, Burlingame, CA 94010-3224 | 2010-03-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568071850 | Jilla Lavian | Social Worker | 1240 Lakeview Drive, San Mateo, CA 94010 | 2020-07-23 |
| 1982246575 | Golden State Heart & Vascular Associates | Internal Medicine | 1850 El Camino Real Ste 200, Burlingame, CA 94010 | 2019-10-15 |
| 1184182248 | Primrose Healing and Wellness, Inc. | Marriage & Family Therapist | 405 Primrose Rd, #320, Burlingame, CA 94010 | 2019-03-07 |
| 1720508724 | Monazza Chaudhry | Pharmacist | 1828 El Camino Real #104, Burlingame, CA 94010 | 2017-06-21 |
| 1861804007 | Heidi Platt | Counselor | 826 Mahler Road, Burlingame, CA 94010 | 2014-05-22 |
| 1144662685 | Scarlett M Reyes | Counselor | 1818 Gilbreth Road, Suite 230, Womens Recovery Association, Burlingame, CA 94010 | 2013-07-25 |
| 1760821979 | Elliot Naidus | Internal Medicine | 1720 El Camino Real Ste 150, Burlingame, CA 94010 | 2013-06-20 |
| 1831430651 | Huddleston Care, LLC | In Home Supportive Care | 1364 Drake Avenue, Burlingame, CA 94010 | 2013-03-04 |
| 1891070843 | Linda Susan Notario | Pharmacist | 260 El Camino Raal, Burlingame, CA 94010 | 2011-10-20 |
| 1063794006 | Tram Anh Le | Pharmacist | 260 N El Camino Real, Burlingame, CA 94010 | 2011-09-15 |
| Find all providers in zip 94010 | ||||
| Taxonomy Code | 246ZS0410X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Specialist/Technologist, Other |
| Specialization | Surgical Technologist |
| Surgical technologists are allied health professionals, who are an integral part of the team of medical practitioners providing surgical care to patients. Surgical technologists work under the supervision of a surgeon to facilitate the safe and effective conduct of invasive surgical procedures, ensuring that the operating room environment is safe, that equipment functions properly, and that the operative procedure is conducted under conditions that maximize patient safety. Surgical technologists possess expertise in the theory and application of sterile and aseptic technique and combine the knowledge of human anatomy, surgical procedures, and implementation tools and technologies to facilitate a physician's performance of invasive therapeutic and diagnostic procedures. |
| Notes: Source: Association of Surgical Technologists, "Job Description: Surgical Technologist," 2014. [7/1/2014: code modified, title modified, definition added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528254117 | Peninsula Surgical Specialist Medical Group, Inc | Specialist/Technologist, Other | 1720 El Camino Real, Suite 101, Burlingame, CA 94010-3224 | 2007-09-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841787447 | Eddie A Mendoza | Specialist/Technologist, Other | 1900 E Tahquitz Canyon Way Ste A1, Palm Springs, CA 92262-7060 | 2018-04-18 |
| 1932568391 | Nicholas A. Tenney | Specialist/Technologist, Other | 6509 Brynhurst Ave, Apt 3, Los Angeles, CA 90043-4328 | 2016-02-15 |
| 1932598612 | Ofelia Loani Elvir Lazo | Specialist/Technologist, Other | 467 Arnaz Dr Apt 317, Los Angeles, CA 90048-6708 | 2015-01-17 |
| 1548664857 | Evelyn Mejia | Specialist/Technologist, Other | 1229 W Fairgrove Ave, West Covina, CA 91790-4611 | 2014-10-15 |
| 1871994129 | Rachel Gates | Specialist/Technologist, Other | 1000 Escalon Ave Apt Q2134, Sunnyvale, CA 94085-4135 | 2014-09-05 |
| 1194064360 | Neuro Dynamics | Specialist/Technologist, Other | 16837 Los Alimos St, Granada Hills, CA 91344-5054 | 2013-02-07 |
| 1538413869 | Gabriel G Sanchez | Specialist/Technologist, Other | 8185 E Ave, Hesperia, CA 92345-1509 | 2012-11-08 |
| 1184984411 | Thomas M Dixon | Specialist/Technologist, Other | 1908 Blenheim St, Riverside, CA 92507-2008 | 2012-05-21 |
| 1013213255 | Lemuel Lopez Novencido | Specialist/Technologist, Other | 106 Monroe St, Oceanside, CA 92057-4418 | 2011-02-07 |
| 1427295674 | Steven Jay Lombardo | Specialist/Technologist, Other | 351 Sante Fe Drive, St.100, Encinitas, CA 92024-5137 | 2009-01-09 |
| Find all providers with the same taxonomy | ||||
| City | BURLINGAME |
| Zip Code | 94010 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.