NPIMap

Individual provider Active NPI

Gordon Hyeonjin Bae, MD

  • Dermatology Physician
  • Stanford, CA
National Provider Identifier
1003265653
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A150572 Issued in CA
Practice address
300 Pasteur Dr
Stanford, CA 94305-2200
Phone
(650) 723-4000
NPI assigned
Jun 5, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X A150572 CA Primary

Addresses

Primary practice location

300 Pasteur Dr
Stanford, CA 94305-2200

Mailing address

450 Broadway St
Redwood City, CA 94063-3132
Phone (650) 723-6316

Other practice location 1

450 Broadway St
Redwood City, CA 94063-3132
Phone (650) 723-6316

Other practice location 2

75 Francis St
Boston, MA 02115-6110
Phone (617) 732-5500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190725003238 CA Practitioner - Dermatology 9133413867 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Harvard Medical School, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Stanford Health CareGroup PAC ID 6709797491, 3,152 clinicians

Practice addresses (Care Compare)

300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000

420 Broadway St
Redwood City, CA 94063-3132
Phone (650) 723-4000

450 Broadway St
Redwood City, CA 94063-3132
Phone (650) 723-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.53 of 100Reported as group
Quality
87.08
Promoting interoperability
100
Improvement activities
40
Cost
69.51

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision12
Removal of tissue1-10
Removal of skin lesions969
Removal or shaving of skin growth125
Skin biopsy118

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A150572CAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stanford Health Care CurrentSince May 28, 2020 Accepting new patients
Stanford Health Care Dermatology Current Accepting new patients
LPCH Medical Group Div of Lucile CurrentSince May 28, 2020 Accepting new patients
Stanford Health Care CurrentSince May 28, 2020 Accepting new patients
Stanford Hospital and Clinics Past Accepting new patients
John Muir Health Past Accepting new patients
Lucile Salter Packard Children'S Hospital at Stanford Past Accepting new patients

Locations

960 N San Antonio Rd
Los Altos, CA 94022
Phone (650) 724-8844

7999 Gateway Blvd
Ste 200
Newark, CA 94560
Phone (510) 806-2947

725 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8979

450 Broadway St
Redwood City, CA 94063
Phone (650) 723-5643

450 Broadway St
Fl 2
Redwood City, CA 94063
Phone (650) 498-3931

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

Interoperability endpoints

  • Direct secure messaging: gbae181586@direct.stanfordhealthcare.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1003265653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 BROADWAY ST",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940633132",
            "telephone_number": "650-723-6316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 Broadway St",
            "address_purpose": "LOCATION",
            "city": "Redwood City",
            "state": "CA",
            "postal_code": "940633132",
            "country_code": "US",
            "telephone_number": "650-723-6316",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "75 Francis St",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021156110",
            "country_code": "US",
            "telephone_number": "617-732-5500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAE",
        "first_name": "GORDON",
        "middle_name": "HYEONJIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-05",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A150572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanford, CA

Sources for this page

Verify at the official NPI Registry.