NPIMap

Organization Active NPI

Stanford Health Care

Doing business as SHC Radiation Oncology

  • Radiation Oncology Physician
  • Pleasanton, CA
National Provider Identifier
1124561758
Registry record updated Mar 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
070000662 Issued in CA
Legal business name
STANFORD HEALTH CARE
Doing business as
SHC Radiation Oncology
Practice address
5725 W Las Positas Blvd
Suite 100B
Pleasanton, CA 94588-4054
Phone
(650) 723-4000
NPI assigned
Nov 30, 2016
Last updated
Mar 9, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2017

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

Authorized official

Name
David Connor
Title
Cfo
Phone
(650) 725-1074

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 070000662 CA
Radiation Oncology Physician 2085R0001X 070000662 CA Primary
Diagnostic Radiology Physician 2085R0202X 070000662 CA

Addresses

Primary practice location

5725 W Las Positas Blvd
Suite 100B
Pleasanton, CA 94588-4054

Mailing address

1804 Embarcadero Rd
Suite 100
Palo Alto, CA 94303-3341
Phone (650) 498-5710

Other names 1

  • SHC RADIATION ONCOLOGY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030731000003 CA Part A Provider - Hospital 6709797491 6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Jose, CA; Los Altos, CA; Stanford, CA; Palo Alto, CA; Emeryville, CA; Pleasanton, CA; Los Gatos, CA; Redwood City, CA…
O20031124000348 CA Part B Supplier - Clinic/Group Practice 6709797491 Receives reassigned benefits from 4,611 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Redwood City, CA; Pleasanton, CA; San Diego, CA; San Jose, CA; San Ramon, CA; Santa Maria, CA; Stanford, CA; Templeton, CA…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124561758. Details of each certification follow.

Hospital certification: CCN 050441

Legal name
STANFORD HEALTH CARE
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1968
Last certification
Jul 25, 2025
Beds
613
Ownership / control type
Private (not for profit)
Most recent change of ownership
Apr 1, 2000 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Apr 12, 1957 in CA
Enrollment address
300 Pasteur Dr
Stanford, CA 94305-2200
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Psychiatric unit, Rehabilitation unit, Other

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Stanford Health CareCCN 050441 · All quality measures
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Stanford Hospital & ClinicsCCN 05T441
Ownership
Non-profit
Certified
Sep 1, 1992

This is a unit of this hospital with its own CMS Certification Number. Care Compare reports it separately, and it has no NPI of its own. How units are connected

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0695789Stanford Health Care5725 W Las Positas Blvd, Pleasanton, CA 94588RegistrationJul 31, 2027

National Provider Directory

National Provider Directory

Locations

5725 W Las Positas Blvd
Ste 100A
Pleasanton, CA 94588
Phone (833) 444-7622

Ownership & related parties

All disclosed owners & managing parties 35

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lloyd Brooks Minor Individual Corporate DirectorBoard Member Dec 1, 2012
Mindy Rogers Individual Corporate OfficerBoard Member Vice Chair Nov 1, 2018
Eila C Skinner Individual Corporate OfficerBoard Member Jan 1, 2023
Rachelle Nolan Individual W-2 Managing EmployeeProvider Enrollment Coor Oct 12, 2015
Lata Krishnan Individual Corporate OfficerBoard Member Apr 1, 2018
Gurinder Sarao Individual W-2 Managing EmployeeCredentialing Assistant Sep 1, 2017
Amit Sinha Individual Corporate OfficerBoard Member Apr 1, 2023
Jill Buathier Individual W-2 Managing EmployeeChief Revenue Cycle Officer Feb 28, 2013
Operational/Managerial ControlChief Revenue Cycle Officer Feb 28, 2013
Hamid R Moghadam Individual Corporate OfficerBoard Member Sep 1, 2021
Kavitark R Shriram Individual Corporate OfficerBoard Member Sep 1, 2019
The Board of Trustees of the Leland Stanford Junior University Organization, Stanford, CA Corporation Other Jul 1, 1968
Naira Guerrero Individual W-2 Managing EmployeeCredentialing Assistant Nov 18, 2018
Robert T Santos Individual Corporate OfficerBoard Member Jan 1, 2021
Hanh Truong Individual W-2 Managing EmployeeProvider Enrollment Coor Nov 16, 2020
Jeffrey J Rothschild Individual Corporate OfficerBoard Member Jan 1, 2021
Mark Leslie Individual Corporate OfficerBoard Member Sep 1, 2015
Paul King Individual Corporate OfficerBoard Member Jan 28, 2019
Karen Jordan Individual Corporate OfficerBoard Member Jan 1, 2023
Susan Bechtel Individual Corporate OfficerBoard Member Nov 1, 2015
Stanford Health Care Organization, Stanford, CA Non-profit 5% Or Greater Direct Ownership Interest Feb 27, 2013 100%
Thomas Jude Montine Individual Corporate OfficerBoard Member Jan 1, 2022
Randall Livingston Individual Corporate OfficerUniversity Liaison for Stanford Jan 1, 2019
Sara Abbasu Individual Corporate OfficerBoard Member May 1, 2021
Mariann Byerwalter Individual Corporate OfficerBoard Member Apr 1, 2000
David Entwistle Individual Corporate OfficerPresident & Ceo Jul 5, 2016
W-2 Managing EmployeePresident & Ceo Jul 5, 2016
Kaye Foster Individual Corporate OfficerBoard Member Nov 1, 2014
Cecilia Herbert Individual Corporate OfficerBoard Member Sep 1, 2016
Cynthia Gulick Individual Corporate DirectorDirector, MSS & Credentialing Sep 7, 2021
W-2 Managing Employee Sep 7, 2021
William Brody Individual Corporate OfficerBoard Member Nov 1, 2015
Jay Bakul Shah Individual Corporate OfficerBoard Member Sep 1, 2022
Lisa M Sangam Individual W-2 Managing EmployeeManager of MSSD Sep 7, 2021
Jeffrey W Bird Individual Corporate OfficerBoard Member Jan 1, 2022
Gladys Rufo Individual W-2 Managing EmployeeProvider Enrollment Coor Nov 7, 2016
Marc Jones Individual Corporate OfficerBoard Member Chair Jan 1, 2020
Jonathan Jay Coslet Individual Corporate OfficerBoard Member Jan 1, 2022

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1,471

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 1,471

Affiliated clinicians 3,901

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 3,901

NPI Registry JSON

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

{
    "created_epoch": "1480464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489017600000",
    "number": "1124561758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 EMBARCADERO RD",
            "address_2": "SUITE 100",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943033341",
            "telephone_number": "650-498-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5725 W LAS POSITAS BLVD",
            "address_2": "SUITE 100B",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945884054",
            "telephone_number": "650-723-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANFORD HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-30",
        "last_updated": "2017-03-09",
        "status": "A",
        "authorized_official_last_name": "CONNOR",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "650-725-1074"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "070000662",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "CA",
            "license": "070000662",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "070000662",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHC RADIATION ONCOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pleasanton, CA

Sources for this page

Verify at the official NPI Registry.