Organization Active NPI

Paradigm Surgical Specialist PC

  • Plastic Surgery Physician
  • San Rafael, CA
National Provider Identifier
1023411964
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
PARADIGM SURGICAL SPECIALIST PC
Practice address
1050 Northgate Dr Ste 510
San Rafael, CA 94903-2542
Phone
(415) 250-9251
NPI assigned
Oct 7, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Authorized official

Name
Dr. David M Young, M.D.NPI 1538127311
Title
Administrator
Phone
(415) 250-9251

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X Primary

Addresses

Primary practice location

1050 Northgate Dr Ste 510
San Rafael, CA 94903-2542

Mailing address

1050 Northgate Dr Ste 510
San Rafael, CA 94903-2542
Phone (415) 250-9251

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141205002036 CA Part B Supplier - Clinic/Group Practice 0042532863 Receives reassigned benefits from 3 practitioners
Practice locations: Novato, CA; San Francisco, CA; San Rafael, CA

National Provider Directory

National Provider Directory

Locations

6399 San Ignacio Ave
Ste 120
San Jose, CA 95119
Phone (408) 369-5620

1050 Northgate Dr
Ste 510
San Rafael, CA 94903
Phone (415) 250-9251

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1023411964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 NORTHGATE DR STE 510",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032542",
            "telephone_number": "415-250-9251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 NORTHGATE DR STE 510",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032542",
            "telephone_number": "415-250-9251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARADIGM SURGICAL SPECIALIST PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-07",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "415-250-9251",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.